肝门部胆道引流管折叠技术在肝移植后胆道非吻合口狭窄治疗中的应用

目的 介绍全新设计经皮经肝胆道引流管肝门部胆管折叠技术,以单一入路实现双侧胆道支撑引流;研究该技术在治疗原位肝移植后肝门部非吻合口胆道狭窄中的疗效和安全性.方法 2000年7月至2010年7月收治10例原位肝移植后非吻合口胆道狭窄患者.胆道狭窄处予球囊扩张,胆道引流管置入后,在肝门部胆管内折叠成Y形,实现左、右肝管并肝总管三向支撑引流.分析其技术成功率、临床疗效、并发症率及复发率等.结果 技术成功率为10/10.9例临床症状缓解,生化指标恢复正常,影像学检查有明显改善.26个月(中位数)的随访中,未见复发.2例有轻微并发症.1例治疗失败,行第2次肝移植后死亡.结论 经皮经肝胆道引流管肝门部胆管汇合部折叠技术在技术上是可行的;在原位肝移植后非吻合口肝门部胆道狭窄治疗中的初步应用结果表明,其技术成功率、疗效、安全性均令人满意.

The application of biliary catheter folding technique in the treatment of hilar nonanastomotic biliary strictures after orthotopic liver transplantation

Objective To introduce a newly-designed percutaneous single catheter folding technique, by which bilateral biliary drainage and stenting can be completed through single access,and to assess the effectiveness and safety of this technique in treating hilar nonanastomotic strictures occurred after orthotopic liver transplantation.Methods A total of 10 patients with nonanastomotic strictures,who were encountered during the period from July 2000 to July 2010 in authors’ hospital,were enrolled in this study.Balloon dilatation was used for the biliary tract stenosis.After the placement of biliary drainage tube,the catheter was folded into "Y" shape within the biliary duct at hepatic portal region,and triaxial supporting drainage,i.e. the left hepatic duct,the right hepatic duct and the common hepatic duct,was established.The technical success rate,the clinical efficacy,the complications and the recurrence were documented and analyzed. Results Technical success rate was 100%(10/10).In 9 patients,the clinical symptoms were obviously relieved,the biochemical indexes were gradually restored to normal and the imaging findings were markedly improved.During the follow-up period lasting 26 months(median),no recurrence was seen.Minor complications occurred in two cases.One patient died after he received second orthotopic liver transplantation because of failure to respond to initial treatment.Conclusion Percutaneous transhepatic biliary catheter folding technique is technically feasible.The results of this study indicate that this technique carries satisfactory success rate and is very effective and safe for the treatment of hilar nonanastomotic strictures occurred after orthotopic liver transplantation.