两种十二指肠乳头预处理方法治疗肝移植术后胆管狭窄的疗效比较

目的比较内镜下乳头括约肌切开术(endoscopic sphincterotomy,EST)与内镜下乳头括约肌球囊扩张术(endoscopic papillary balloon dilatation,EPBD)这两种不同的预处理方法,联合内镜下多塑料支架置入,治疗肝移植术后胆管狭窄的不同疗效。方法回顾性分析上海中医药大学附属曙光医院2011年11月至2016年3月,67例行EST或EPBD联合内镜下多塑料支架治疗肝移植术后胆管狭窄患者的临床资料,对其狭窄消除率、术后近期和远期并发症进行比较分析。结果 EST组与EPBD组的狭窄消除率分别为89.3%和94.9%(P0.05);EST组与EPBD组近期总体并发症发生率分别为25.0%和12.8%(P0.05);出血发生率EST组(10.7%)明显高于EPBD组(0)(P0.05),3例出血均在内镜下有效止血;远期胆管结石复发合并急性胆管炎的发生率,EST组(46.4%)明显高于EPBD组(15.4%)(P0.05)。结论 EPBD联合多塑料支架置入治疗肝移植术后胆管狭窄时,近期出血率和远期并发症低于EST,推荐首选EPBD。

Efficacy comparison of two pretreatment methods on the patients suffered from biliary stricture after liver transplantation

Objective To investigate the clinical effects of endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD) before indwelling multiple plastic stents, on the patients suffered from bili-ary stricture after liver transplantation. Methods Clinical data of 67 patients who accepted EST or EPBD com-bined with multiple stents, between Nov. 2011 to Mar. 2016 were collected retrospectively. Cure rate of stenosis, early and long-term complications were analyzed. Results Cure rates of stenosis were 89.3% in EST group and 94.9% in EPBD group (P>0.05). The total rates of early complications were 25.0% and 12.8% (P>0.05), while hemorrhage rates were 10.7% in EST group and 0 in EPBD group (P<0.05). However, 3 cases of hemorrhage were cured with conservative treatment. 46.4% patients in EST group and 15.4% in EPBD (P<0.05) group had encountered recurrent calculus of bile duct and cholangitis after ERCP. Conclusion EPBD combined with mul-tiple stents is a preferred choice for the patients of biliary stricture after liver transplantation, with a lower rate of hemorrhage and long-term complications.