经内镜诊治肝移植术后胆道远期并发症

目的：探讨经内镜逆行胰胆管造影(ERCP)在诊断和治疗肝移植患者胆道远期并发症中的应用。方法：肝移植术后出现胆道远期并发症患者6例，共行ERCP 12次，根据患者的情况进行扩张、内镜下乳头切开取石、内支架置入等治疗。结果：1例胆总管结石行乳头切开后取石成功，1例胆道狭窄在胆道扩张后胆道梗阻症状解除，4例胆道狭窄合并胆总管结石的狭窄近端结石经乳头切开取出，狭窄远端结石行胆道扩张、内支架置入等治疗后取出。所有患者经治疗后胆红素、碱性磷酸酶等酶学指标均有不同程度的下降，无严重并发症发生。结论：ERCP是诊断和治疗肝移植患者胆道远期并发症安全、有效的手段。

Biliary tract complications of liver transplantation treated by endoscopic retrograde cholangiopancreatography

Objective To investigate the role of endoscopic retrograde cholangiopancreatography in diagnosis and treatment of the late biliary tract complications after orthotopic liver transplantation. Methods Twelve times of ERCP were undergone in six patients. The biliary tract complications including common bile duct stones and biliary stricture were treated respectively by endoscopic sphincterotomy ( EST) with stone extraction and stricture dilation and/or endoscopic retrograde biliary drainage (ERBD). Results One patient with common bile duct stone successfully received EST with stone extraction. Four patients with both biliary stricture and common bile duct stones, received ERCP when the stones located distal to the stricture, while those located proximal to the stricture dilation and ERBD were undergone first, two months later EST with stone extraction was conducted. One case with biliary tract stricture recovered after dilation alone. After treatment the biochemical assay of blood samples showed recovery in different extents and had no severe ERCP - related complication happened. Conclusion ERCP is an effective and safe measure in diagnosis and treatment of the late biliary tract complications after orthotopic liver transplantation.