经T管窦道网篮取泥治疗肝移植术后胆泥综合症

目的探讨经T管窦道网篮取泥在肝移植术后胆泥综合症治疗中的应用价值。 方法回顾性分析2008年1月～ 2013年5月,经T管窦道网篮取泥治疗肝移植术后胆泥综合症的39例病人。所有病人均于术后3个月经T管造影诊断为胆泥形成。所有病人均采用3F网篮取除胆管内胆泥,并对伴有胆道狭窄的病人行球囊扩张,最后留置6~10F引流管。 结果39例病人中29例1次性完整取出胆树状铸型胆泥,10例取出部分絮状胆泥,6例病人因胆泥复发再次行经T管窦道网篮取泥治疗。除3例病人术后并发严重胆管炎外,无其他与介入治疗相关并发症发生。 结论经T管窦道网篮取泥可早期解除胆管梗阻,可作为治疗肝移植术后早期胆管内胆泥的一种方法。     

原位肝移植术后胆道狭窄的介入治疗

目的:探讨经T型管及其窦道和经皮肝穿刺胆道引流治疗原位肝移植术后胆道狭窄的可行性及其疗效.方法:对252例原位肝移植术后出现胆道狭窄的26例患者分别行胆道气囊扩张术、胆道引流术和胆道支架置入术.结果:3例胆道狭窄合并胆瘘患者和3例单纯吻合口狭窄患者,经气囊扩张术和胆道引流后痊愈.6例肝内外胆管多发狭窄患者,气囊反复扩张胆道狭窄段后,5例狭窄纠正而获得痊愈;1例气囊扩张治疗后出现肝内血肿,再次行肝移植.12例肝内外胆管多发狭窄合并胆泥的患者,经反复球囊导管扩张后,10例狭窄明显减轻,黄疸缓解;1例置入胆道支架,后因支架管阻塞而再次肝移植;1例治疗后狭窄仍存在,黄疸无缓解而再次肝移植.2例T型管引流口段狭窄行经皮肝穿刺胆道引流术后,狭窄明显减轻,黄疸缓解.结论:经T型管及其窦道和经皮肝穿刺胆道引流是治疗原位肝移植术后胆道狭窄的良好方法.     

肝移植术后胆道并发症的介入诊疗

目的 探讨介入手段在诊断和治疗肝移植术后胆道并发症的应用,分析移植术后T管留置的价值.方法 回顾性分析55例肝移植术后胆道并发症患者的介入诊治资料,分析有无T管所需采取的介入治疗方式.结果 保留T管的28例患者经造影证实胆道并发症存在后需进行介入治疗的17例,仅需通过原T管引流治疗的11例,而仅需进行球囊扩张后仍以T管引流的3例,需行经皮经肝胆道引流(PTBD)治疗(和辅以球囊扩张)的14例;无T管的27例患者全部进行经皮经肝胆管造影(PTC)诊断发现梗阻病变并予以介入治疗.共发现8例同时存在血管并发症并予以相应处理.所有患者在介入治疗后黄疸均明显消退,技术成功率100%,短期(1个月)缓解率100%.结论 对于肝移植术后胆道并发症患者,介入治疗安全、可靠,可重复性好,具有不可替代的作用;术后留置T管可为部分患者提供针对胆道梗阻进行造影诊断与引流治疗的途径,但大部分患者仍需介入手段干预,才能达到满意的治疗效果.     

肝移植术后并发胆道狭窄的内镜下治疗

 目的:初步探讨内镜在肝移植术后胆道狭窄治疗中的临床应用价值.方法:通过十二指肠镜逆行胆管造影(endoscopic retrograde cholangiography,ERC)检查对肝移植术后胆道狭窄进行诊断,并根据检查结果做相应的内镜下介入治疗.结果:肝移植术后胆道狭窄38例,其中21例为吻合口狭窄(10例合并有胆瘘),17例为非吻合口胆道狭窄.针对不同情况进行鼻胆管引流术及塑料支架引流术等治疗,非吻合口胆道狭窄的患者内镜治疗较困难,需要多次进行内镜治疗.所有患者治疗后临床症状均明显改善,无严重并发症发生.结论:内镜对于肝移植术后胆道狭窄并发症的诊断与治疗安全而有效,胆道狭窄并发症的较快发现及时处理可使患者较快治愈.     

肝移植术后血管胆道并发症的介入治疗

目的:评价介入治疗对肝移植后胆道、血管并发症的价值。材料和方法:18例肝移植患者接受了介入治疗。其中肝动脉狭窄8例,行肝动脉造影及溶栓治疗;下腔静脉及肝静脉狭窄2例,行内支架置入术;胆瘘及胆道狭窄8例,行PTCD治疗。结果:胆道并发症8例,PTCD治疗后症状消失;肝动脉狭窄8例,溶栓后肝动脉完全开放6例,1例血流部分开放,1例肝动脉血流未恢复再次肝移植治疗;下腔静脉及肝静脉狭窄2例内支架置入术后下腔静脉梗阻及肝肿大症状消失。结论:介入治疗是治疗肝移植后胆道血管并发症的有效方法。     

肝移植术后胆道并发症ERCP表现及内窥镜介入治疗

目的探讨肝移植术后胆道并发症的原因及影像学表现,并对部分并发症进行内窥镜介入治疗,以提高肝移植的成功率。方法通过十二指肠镜逆行胰胆管造影(ERCP)检查对肝移植术后胆道异常改变11例资料进行回顾性分析,并根据检查结果做相应的内窥镜下介入治疗。结果通过ERCP检查,对11例肝移植术后患者出现梗阻性黄疸原因得到明确诊断,其中,胆道胆泥形成2例,胆管吻合口狭窄6例,胆道腹腔漏3例。并对2例胆道胆泥进行了乳头括约肌切开(EST) 网蓝胆泥取出术;5例吻合口狭窄行气囊扩张或塑料内支架内引流(ERBD)及2例胆道腹腔漏行鼻胆管引流治疗(ENBD),治疗效果确切,经有针对性的预防和治疗后,除2例胆道腹腔漏分别于肝移植术后6月及11月病死和1例因胆管吻合口处完全阻塞未能放置内支架引流管,导致肝内胆汁淤积症并肝硬化及肝功能失代偿病死外,其余患者均痊愈出院,现仍长期存活,总生存率为72.7%。结论肝移植术后一旦怀疑胆道并发症时应及时行ERCP检查,并根据检查结果做内窥镜介入治疗。胆道并发症的及时发现和处理将可能使患者较快痊愈。     

肝移植术后胆道狭窄经皮肝穿刺胆管造影的并发症及其预防

目的观察经皮肝穿刺胆道介入治疗原位肝移植术后胆道狭窄发生并发症的频次和类型。资料与方法对292例原位肝移植术后出现胆道狭窄的30例患者分别行胆道球囊扩张术、胆道引流术和胆道支架置入术,观察术中反应、术后临床经过、相关实验室检查、B超和复查胆道造影表现。结果 3例(10.0%)胆道狭窄合并胆瘘患者和3例(10.0%)单纯吻合口狭窄患者行气囊扩张术和胆道引流后痊愈。8例(26.7%)肝内外胆管多发狭窄患者气囊反复扩张胆道狭窄段后,7例狭窄纠正而获得痊愈。14例(46.7%)肝内外胆管多发狭窄合并胆泥患者中12例(40.0%)狭窄明显减轻,黄疸缓解;2例(6.7%)T形管引流口段狭窄行经皮肝穿刺胆道引流术后,狭窄明显减轻,黄疸缓解。30例患者(100.0%)术中均感疼痛,其中12例(40.0%)疼痛剧烈。2例(6.7%)术中发生出血,其中1例再次行肝移植。27例(90.0%)术后胆管仍再狭窄,需反复多次成形。2例(6.7%)治疗后狭窄持续存在而再次行肝移植,其中1例曾置入胆道支架,另1例直接行二次肝移植。结论疼痛、再狭窄是经皮肝穿刺胆道介入治疗肝移植术后胆道狭窄的常见并发症,术中预防大出血是降低风险的关键。     

肝移植术后胆管狭窄的介入治疗

目的对肝移植术后胆管狭窄的介入治疗疗效进行初步探讨和总结。方法350例接受原位肝移植的病人,35例通过胆道造影确诊为胆道狭窄,对这32例病人进行了介入治疗,并对治疗前后影像学表现及临床表现进行对比观察。结果30例病人介入治疗获得成功,2例治疗无效,未发生与介入治疗相关的并发症;随访期间12例分别于1～4个月内出现再狭窄,均再次行球囊扩张治疗。结论介入治疗对于肝移植术后胆道狭窄是一种有效而且安全的治疗方法,具有很大应用价值。     

肝移植术后血管并发症的介入诊断与治疗(附5例报告)

目的　探讨肝移植术后血管并发症介入诊断与治疗的价值。方法　搜集本院肝移植术后因血管并发症行DSA造影检查或介入治疗的 5例患者的相关资料 ,进行回顾性分析。结果　全部病例操作均顺利。造影发现肝动脉血栓 (HAT) 1例、肝动脉狭窄 (HAS) 2例、门静脉狭窄并血栓形成 3例、肝静脉狭窄 1例、下腔静脉狭窄 1例、上腹腔炎症性改变 1例 ,发生肝固有动脉痉挛 1例。其中 ,HAT、门静脉狭窄并血栓形成、肝静脉狭窄各 1例行介入治疗后 2例效果明显。结论　介入技术对于肝移植术后血管并发症的诊治具有较大价值     

双引流管技术在四例肝移植术后胆道狭窄中的应用

目的 探讨双引流管技术在治疗肝移植术后胆道狭窄中的应用价值.方法 回顾性分析采用双引流管技术治疗4例肝移植术后胆道狭窄病例的资料.采用经皮经肝穿刺胆道引流介入技术,建立1～2条引流道置入双引流管.结果 4例胆道并发症均患者表现为肝内胆管和胆总管多发狭窄合并胆泥形成.患者平均年龄55岁,供肝冷缺血时间11.4 h、热缺...     

经皮肝穿胆道引流术治疗肝移植术后胆道并发症

目的 评价介入方法治疗肝移植术后胆管并发症的价值.方法 回顾性分析1999年10月-2005年10月肝移植术后发生的6例胆道并发症的相关资料,其中胆总管狭窄2例、胆总管狭窄并胆瘘1例、胆瘘1例、胆汁瘤2例.结果 术后出现胆道并发症患者,经皮肝穿胆道引流治疗5例,放置胆道支架1例.手术均取得成功,患者的临床症状有所好转.结论 介入方法治疗肝移植术后胆管并发症可减少再手术创伤,提高生存率与生存质量,具有良好的近期效果.     

介入治疗T管引流术后胆道再狭窄的初步探讨

目的 评价介入治疗外科T管引流后胆道再狭窄的疗效、安全性、可行性.方法 回顾性分析2014年6月-2016年3月收治的T管术后胆道再狭窄的25例患者资料,其中胆管癌6例,胆囊癌3例,胆系结石13例,肝癌2例,胃癌外科术后1例.25例中合并胰胆管合流异常4例.经原T管途径行介入治疗22例,经T管造影后再行PTCD治疗3例.所有患者中,行球囊扩张配合胆道引流者21例,行胆道金属支架植入者4例.良性狭窄患者引流管保留2～3个月后给予拔除.患者经门诊或电话随访3～24个月,通过引流管造影评价疗效.结果 介入手术均顺利,无相关并发症发生,技术成功率100％.15例良性胆道狭窄患者经原T管窦道途径行球囊扩张成形术,留置胆道10.2～12 F内外引流管,拔除原T管.随访发现1例胆管癌吻合口狭窄患者术后8个月死于肺部感染.10例恶性狭窄中,3例胆道梗阻位于T管上方,均行PTCD术;其中2例肝癌侵犯胆道患者,癌栓范围较大,行内外引流管植入;黄疸消退后分别于术后1个月、2.2个月死于肝衰竭;1例胆囊癌侵犯胆道行支架植入,术后2.5个月死于肿瘤进展.7例胆道梗阻位于T管下方,经T管窦道途径植入内外引流管4例,植入金属支架3例.其中2例胆囊癌患者分别于术后3.8个月、5个月死于肿瘤进展;5例胆管癌患者中2例术后3个月出现支架再狭窄,给予PTCD处理.3例于术后3.6个月、5.2个月、9个月死于肿瘤进展、多脏器功能衰竭.结论 介入治疗外科T管引流后胆道再狭窄疗效确切,安全可行,可明显改善患者生活质量.     

肝移植术后早期胆道并发症65例诊治体会

目的探讨肝移植术后早期胆道并发症的诊断和治疗。方法回顾性分析了我院2006年5月～2008年3月以来成功实施的65例肝移植的临床资料。其中尸肝移植54例，亲体肝移植11例，女性占16．92％（11／65），男性占83．08％（54／65）。结果本组65例肝移植患者其中有8例3个月内出现胆道早期并发症，发生率为12．31％（8／65），分别为胆漏3例，胆汁瘤1例，肝内胆汁湖1例，胆泥形成1例，胆道狭窄2例。女性患者早期胆道并发症发生率为9．09％（1／11），男性患者早期胆道并发症发生率为12．96％（7／54）。8例患者中，留置T管引流1例，未留置T管引流7例。治愈6例，好转2例，死亡0例（0％）。其中3例术后3d内出现单纯胆漏，通过留置的腹腔引流管得到及时的诊断，同时应用留置的腹腔引流管持续引流4周～2月后得到治愈。5例经B超、MRCP、ERCP得到诊断；1例胆汁瘤和1例肝内胆汁湖通过B超引导下穿刺引流而得到治愈；1例胆泥形成通过ERCP进行胆道冲洗后好转出院；2例通过ERCP进行球囊扩张或者放置支架后好转出院。结论肝移植术后早期胆道并发症的诊断主要手段是留置的腹腔引流管、B超、MRCP、ERCP等：肝移植术中留置的腹腔引流管对于肝移植术后早期胆漏的治疗起着特殊的作用：B超引导下穿刺引流是治疗胆汁瘤、胆汁湖的重要手段；ERCP下胆道冲洗对胆泥形成非常有效．ERCP下球囊扩张或者放置胆道支架对胆道狭窄的治疗很有效。     

The role of interventional radiology in biliary complications after orthotopic liver transplantation: a single-center experience

This study evaluated interventional radiological experience in the management of biliary complications of OLT at the National Cancer Institute of Milan. Seventeen patients who had undergone orthotopic liver transplantation in various hospital were referred to our unit with biliary complications. Group I consisted of 8 patients with anastomotic biliary fistula who came to our attention a short time after transplantation. Group II consisted of 9 patients with anastomotic strictures who came to our attention in a longer period. Two different interventional radiological approaches were used: (a) percutaneous transhepatic biliary drainage (PTBD) in the presence of fistulas in patients of group I; and (b) percutaneous transhepatic biliary drainage combined with dilatation of the strictures with a balloon catheter in patients of group II. On the whole resolution of the biliary complications was achieved in 13 of the 17 cases treated (76.5%), 5 of 8 in group I and 8 of 9 in group II. No secondary stenosis after PTBD were observed in group I, whereas two patients of group II needed a second dilatation. Percutaneous biliary drainage is indicated as a valid treatment in the management of biliary complications, either to allow closure of the fistula either to perform balloon dilatation of stenosis.     

MR cholangiography in biliary complications after liver transplantation in children

PURPOSE: To evaluate the role of MR Cholangiography in a pediatric population with biliary complications after liver transplantation and particularly with anastomotic stenosis. PATIENTS AND METHODS: Ten MR cholangiography studies were performed in 10 children with liver transplant who were suspected of having biliary complications between December 1996 and April 1998. The findings on MR were correlated with the results from liver biopsy, liver ultrasound, liver function tests and with clinical information when available. RESULTS: MR cholangiography identified 9 children with biliary tree dilatation, 4 with anastomotic stenosis, 5 with multiple bile ducts stenosis, 2 with stones in the intra-hepatic biliary tree and 2 with abnormalities suspicious for acute cholangitis. Three of 4 anastomotic stenoses were confirmed and treated by percutaneous cholangiography. There was no correlation between the different exams in 6 children but MR cholangiography confirmed the final diagnosis. CONCLUSION: In children with liver transplantation, MR cholangiography may be useful to evaluate and to confirm a diagnosis of bile duct complications and it is helpful in the absence of correlation between liver biopsy, ultrasound and liver function test.     

Liver transplantation: role of the radiologic methods in the postoperative period]

Some complications of liver transplantation appear as aspecific clinical and blood test abnormalities; others--e.g., hepatic artery thrombosis in the immediate postoperative period and stenosis of the biliary anastomosis before T-tube removal--require early diagnosis. These considerations justify the need of frequent radiologic examination in both the complicated course and the follow-up. The authors report their experience in 59 adult patients submitted to liver transplantation for irreversible liver disease in advanced stage (49 with cirrhosis, 10 with HCC; 5 with cholestatic hepatopathy; 3 with fulminant hepatitis; 1 with Budd-Chiari syndrome; 1 with metastatic APUDoma). Two hundred and sixty-three radiological examinations were performed (Doppler US, CT, angiography and cholangiography) which showed numerous early and delayed complications: 13 of them were treated with interventional radiology maneuvers (US-or CT-guided percutaneous drainage of fluid collections, biliary drainage, bilioplasty, arterial transcatheter embolization). Our results demonstrate that diagnostic and operative radiology are essential for the success of liver transplantation; integrated imaging is particularly important in the diagnosis of complications, while interventional radiology techniques can be usefully employed in their treatment.     

肝移植术后血管与胆管并发症介入治疗初探

目的：评价血管造影和胆管造影诊治肝移植术后血管及胆管并发症的价值。方法：46例原位肝移植术后B超提示血流速度不畅或频谱异常，下肢水肿或黄疸的患者16例，进行腹腔动脉造影10例次，下腔静脉造影并球囊扩张或支架置入6例次，经皮肝穿刺门静脉造影并支架置入2例次，经皮肝穿刺胆管造影并引流4例次。结果：肝动脉血栓形成2例，1例经溶栓治疗后部分开通；肝动脉狭窄4例，1例球囊扩张后狭窄减轻；所有下腔静脉和门静脉阻塞或狭窄行球囊扩张及置放支撑架后临床症状好转，4例胆管狭窄和吻合口瘘者行经皮肝穿刺胆管造影引流（PTCD）治疗后黄疸减轻。结论；对肝移植术后出现的血管和胆管并发症，血管造影和胆管造影不仅可明确诊断，而且能同时工取得较好的近期疗效。     

Biliary complications following orthotopic liver transplantation

The gall-bladder conduit anastomosis (choledocho-cholecysto-choledochostomy) has been the most frequently used technique for the biliary tract anastomosis in the Cambridge/King's College Hospital joint liver transplantation programme since 1976. Cholangiograms and interventional biliary procedures performed over a 3 year period were reviewed retrospectively. Seventy-six of 148 patients managed post-operatively at King's College Hospital were studied (79 transplants). Cholangiograms were abnormal in 63 (80%) transplants with biliary strictures; inspissated bile formation, bile leak and T-tube malposition occurring in 50, 23, 14 and three transplants respectively. Anastomotic strictures occurred most frequently, predominantly at the proximal anastomosis, and the presence of inspissated bile and the T-tube in relation to these contributed towards subsequent biliary obstruction. Non-anastomotic strictures in the donor biliary tract were associated with a high position of the T-tube tip at or above the liver hilum. Saline irrigation of the bile ducts for inspissated bile or its removal via the endoscope were effective measures in the management of biliary obstruction but percutaneous balloon dilatation and endoscopic stent insertion for biliary strictures were found to have a limited role.