超声造影早期检出联合间充质干细胞治疗改善肝移植术后胆道缺血预后的初步探讨

Preliminary study of early diagnosis by contrast-enhanced ultrasound combined with mesenchymal stem cell therapy in improving prognosis of biliary ischemia after liver transplantation

目的探讨超声造影(CEUS)早期检出联合间充质干细胞(MSC)治疗肝移植术后胆道缺血的疗效。方法回顾性分析9例肝移植术后4周内CEUS提示胆道缺血且术后1年内确诊为非吻合口胆管狭窄(NAS)受者的临床资料。常规治疗组4例,行常规治疗,治疗方式包括护肝、利胆、介入治疗等;MSC治疗组5例,在常规治疗的基础上,分别于CEUS提示胆道缺血后1、2、4、8、12和16周接受MSC静脉输注。分析两组受者肝移植术后1年内介入治疗情况和预后。结果MSC治疗组2例受者需接受介入治疗,首次治疗时间为肝移植术后7~9个月,治疗次数1~2次;常规治疗组所有受者均需接受介入治疗,首次治疗时间早于MSC治疗组,为术后1~3个月,治疗次数2~6次。肝移植术后1年内,MSC治疗组2例受者发生弥漫性胆管损伤,未发生移植物失功;常规治疗组所有受者均发生弥漫性胆管损伤,2例受者发生移植物失功。结论应用CEUS早期检出肝移植术后胆道缺血并进行MSC治疗可延缓并减少NAS介入治疗需求,改善受者预后。

Objective To evaluate the clinical efficacy of early diagnosis by contrast-enhanced ultrasound(CEUS)combined with mesenchymal stem cell(MSC)therapy in the treatment of biliary ischemia after liver transplantation.Methods Clinical data of 9 recipients presenting with biliary ischemia detected by CEUS within 4 weeks after liver transplantation and diagnosed with non-anastomotic biliary stricture(NAS)within postoperative 1 year were retrospectively analyzed.In the conventional treatment group,4 recipients were treated with conventional treatment including liver protection,cholagogic therapy and interventional therapy.In MSC treatment group,5 recipients received intravenous infusion of MSC at 1,2,4,8,12 and 16 weeks after biliary ischemia detected by CEUS on the basis of conventional therapy.The interventional treatment and clinical prognosis within 1 year after liver transplantation were analyzed between two groups.Results Two recipients in the MSC treatment group required interventional therapy,which was initially given at 7-9 months after liver transplantation for 1-2 times.All recipients in the conventional treatment group required interventional therapy,which was initially delivered at postoperative 1-3 months for 2-6 times,earlier than that in the MSC treatment group.Within 1 year following liver transplantation,diffuse bile duct injury occurred in 2 recipients in MSC treatment group,and no graft dysfunction was observed.In the conventional treatment group,all recipients developed diffuse bile duct injury,and 2 recipients presented with graft dysfunction.Conclusions Early diagnosis of biliary ischemia after liver transplantation by CEUS combined with MSC therapy may delay and reduce the requirement of interventional therapy for NAS,and also improve clinical prognosis of the recipients.