肝移植术后胆栓形成过程中内镜的诊治价值

目的 探讨内镜逆行胰胆管造影（ERCP）在肝移植术后胆栓形成过程中的诊断治疗价值.方法 71例肝移植术后出现肝功能异常、磁共振检查提示胆道内异物的患者,采用ERCP明确诊断并给予相应的治疗,对其临床资料进行回顾性分析.结果 71例患者共接受188次ERCP诊疗,多数患者伴有不同程度的吻合口和（或）胆管狭窄.术后＜3个月者均取出胆泥,3～6个月者取少量色素样结石,＞6个月者取出铸型胆栓,平均每位患者行2.6次内镜治疗,肝移植术后平均（22.7±15.6）个月形成铸型胆栓.术后发生胰腺炎2例,胆管炎3例,发生率2.6%（5/188）,均经保守治疗控制.随访56例,经内镜处理后患者肝功能均有明显改善,42例达到内镜治愈标准,10例因胆管广泛硬化性改变而行二次肝移植,4例死于移植术以外原因.结论 ERCP处理肝移植术后胆栓形成过程中的胆泥、小结石和胆栓安全可行,近期疗效较好,并可反复进行.

ERCP for diagnosis and management of biliary cast syndrome after liver transplantation

Objective To evaluate endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and management of biliary cast syndrome after orthotropic liver transplantation. Methods A total of 71 consecutive patients with abnormal liver function and MRCP findings after liver transplantation underwent ERCP for diagnosis and management. Their data were retrospectively reviewed. Results A total of 188 sessions of ERCP were carried out on the 71 patients, most of whom were found to have stenosis of anastomotic stoma and/or bile duct. Bile sludge was found and removed in all patients diagnosed within 3 months after liver transplantation, while pigmentoid stones were found and removed in patients diagnosed within 3-6 months and biliary casts in patients diagnosed at more than 6 months. Each patient underwent 2.6 sessions averagely. Biliary casts were formed at an average time of 22. 7 ± 15.6 months after transplantation. PostERCP complications included 2 cases of pancreatitis and 3 cholangitis, with an occurrence rate of 2. 6%(5/188), which were all controlled with conservative treatment. The follow-up data was available in 56 patients showing improvement in liver function after ERCP, among who 42 met the endoscopic criteria of cure,1 0 received second liver transplantation because of progressive sclerosing cholangitis and 4 died from diseases other than liver transplantation. Conclusion Therapeutic ERCP for the biliary cast syndrome after liver transplantation is feasible, safe and effective, and can be performed repeatedly with good short-term effect.