切割球囊治疗肝移植术后胆管吻合口狭窄

Cutting balloon for treatment of bile duct anastomotic stenosis after liver transplantation

目的探讨切割球囊治疗肝移植术后胆管吻合口狭窄的疗效。方法回顾性分析2012年6月至2014年9月在中山大学附属第三医院接受切割球囊治疗的2例肝移植术后胆管吻合口狭窄患者临床资料。患者均签署知情同意书,符合医学伦理学规定。例1男,40岁,诊断为丙型病毒性肝炎、门静脉高压症、脾切除术后。例2男,57岁,诊断为肝占位性病变、乙型病毒性肝炎后肝硬化失代偿期、2型糖尿病。患者行肝移植术后均出现胆管吻合口狭窄,采用切割球囊治疗,球囊扩张时微刀片切割胆管内壁,扩大胆管内径,减少再狭窄。观察切割球囊治疗肝移植术后胆管吻合口狭窄的疗效。结果例1患者行切割球囊治疗后无明显并发症,术后2个月胆管造影显示吻合口狭窄减轻,随访3年黄疸减轻逐步恢复正常。例2患者行切割球囊治疗后胆管轻微出血,予以生长抑素等止血治疗后止血,术后1个月胆管造影显示吻合口狭窄减轻,拔出支架管,随访10个月黄疸减轻逐步恢复正常。结论切割球囊治疗肝移植术后胆管吻合口狭窄安全、有效,可为此类患者提供一种的新治疗选择。

Objective To investigate the clinical efficacy of cutting balloon for treatment of bile duct anastomotic stenosis after liver transplantation （LT）. Methods Clinical data of 2 patients with bile duct anastomotic stenosis after LT who received treatment of cutting balloon in the Third Affiliated Hospital of Sun Yat-sen University between June 2012 and September 2014 were retrospectively analyzed. The informed consents of the patients were obtained and the local ethical committee approval was received. Case 1 was a 40-year-old male and diagnosed with viral hepatitis C, portal hypertension and postsplenectomy. Case 2 was a 57-year-old male and diagnosed with space-occupying lesion in the liver, virus hepatitis B-induced decompensated liver cirrhosis and type 2 diabetes mellitus. Bile duct anastomotic stenosis after LT was observed in both patients, and was treated by cutting balloon. During the balloon expansion, the inner wall of bile duct was cut by micro-knife blade to enlarge the inner diameter of bile duct and reduce the risk of restenosis. The clinical efficacy of cutting balloon for treatment of bile duct anastomotic stenosis after LT was observed. Results No obvious complication was observed in case 1 after cutting balloon treatment. Cholangiography at postoperative 2 months indicated that the anastomotic stenosis was alleviated. The severity of jaundice was alleviated and gradually restored to normal during 3-year to^ow- up. Slight hemorrhage of the bile duct was observed in case 2 after cutting balloon treatment, and was cured by somatostatin. Cholangiography at postoperative 1 month indicated that the anastomotic stenosis was alleviated and the stent tube was removed. The severity of jaundice was alleviated and gradually restored to normal during 10-month follow-up. Conclusions Cutting balloon is a safe and efficacious treatment for bile duct anastomotic stenosis after LT. It can provide a new treatment option for these patients.