ERCP对肝移植术后胆漏的诊疗效果评价

The evaluation of diagnosis and treatment effects of ERCP in bile leaks following orthotopic liver transplantation

目的：评估经内镜逆行胰胆管造影术（ERCP）在原位肝移植术（OLT）后对胆漏的诊疗作用。方法回顾分析我院2013年3月—2016年2月间共12例OLT术后经临床、磁共振胰胆管成像术（MRCP）或术中ERCP证实为胆漏患者的资料，包括胆漏及其合并症的临床症状、发生时间、发生部位、诊疗过程、疗效等临床资料，评价ERCP的诊疗价值。结果本组12例均为男性，年龄35~62岁，平均（49.75±8.55）岁。11例成功行经内镜鼻胆管引流术（ENBD），成功率91.7%；胆漏治愈率91.7%（11/12）；无ERCP相关严重并发症及死亡病例发生；其中9例合并胆管狭窄和（或）伴胆管结石/胆栓者在进行初次ERCP诊疗时行内镜下十二指肠乳头括约肌切开术（EST），并于胆漏愈合2周后行进一步ERCP治疗。除1例ENBD未成功者外，其余随访效果良好。结论 ERCP是OLT术后不同类型胆漏的安全及有效的微创治疗方法。

Objective To evaluate the curative efficacy of endoscopic retrograde cholangiopancreatography （ERCP） on bile leaks after orthotopic liver transplantation （OLT）. Methods Data of 12 cases, hospitalized in our hospital from March 2013 to February 2016, with bile leaks after OLT confirmed by magnetic resonance imaging of the pancreas （MRCP） or ERCP were retrospectively analyzed . The curative efficacy of ERCP was evaluated including clinical symptoms of bile leaks and complications, occurrence time and location, diagnosis and treatment process and efficacy. Results In this study, 12 cases were male patients, with the average age of 49.75 ± 8.55 （age from 35 to 62 years old）. Among them 11 cases were successfully treated by endoscopic nasobiliary drainage （ENBD）, and the success rate of endoscopical therapy was 91.7%, the curative rate of bile leaks was 91.7%（11/12）. No ERCP related serious complications and death were found in patients. Nine cases combined with biliary strictures and/or biliary duct stone/bile plug were performed endoscopic sphinctrotomy （EST） during the first time of ERCP, and accepted further ERCP treatment after 2 weeks when the bile leaks were healed. All patients with ENBD were carried out well except one case. Conclusion ERCP is a safe and effective minimally invasive treatment method for different types of bile leaks after OLT.