经皮经肝胆道镜治疗肝移植术后胆管铸型的安全性及其临床价值观察

目的评价经皮经肝胆道镜治疗肝移植术后胆管铸型的安全性及其临床价值。方法回顾2008年4月至2010年1月间采用经皮经肝胆道镜治疗的11例肝移植术后胆管铸型患者的临床资料，对治疗情况及随访结果进行分析总结。结果11例肝移植术后胆管铸型患者中，1例铸型分布于胆总管内，3例局限于右肝内胆管，4例局限于左肝内胆管，其余3例呈肝内外胆管弥漫分布。11例患者共接受了68例次的经皮经肝胆道镜治疗，其中10例（90．9％）治疗效果良好，肝功能示转氨酶、胆红素等值较治疗前明显降低，余1例因夹闭引流管后偶有发热，给予更换细管长期带管。无一例患者发生胆瘘以及难以控制的出血等严重并发症，只有1例治疗过程中发生瘘道部分断裂，所有患者术后随访10～30个月，1例在随访过程中因其他疾病死亡，其余患者状况良好。结论经皮经肝胆道镜治疗肝移植术后胆管铸型是一种安全、有效的方法，具有较好的应用价值，可在临床上推广应用。

The therapeutic value of percutaneous transhepatic cholangioscopy for biliary cast after liver transplantation

Objective To investigate the value of percutaneous transhepatic cholangioscopy (PTCS) for diagnosis and treatment of biliary cast after liver transplantation. Methods Data of 11 patients with biliary cast after liver transplantation, who underwent PTCS from April 2008 to November 2010, were retrospectively analyzed. Results In 11 patients , one had biliary cast in common bile duct, 3 in right intra-hepatic bile duct, 4 in left intra-hepatic bile duct, and 3 distributed in intra- and extra-hepatic bile ducts. A total of 68 times of PTCS were performed in 11 patients, achieving significant decrease in levels of serum transaminase and bilirubin in 10. Occasional fever occurred in 1 patient after closure of drainage tube,which was managed by replacement with a thinner one. There were no severe complications such as biliary fistula or uncontrollable bleeding. Partial rupture of fistula occurred in 1 case. All patients were followed up for 10-30 months and were all in good condition except one patient died from other disease during the followup. Conclusion PTCS is a safe, effective and applicable method to treat the biliary cast after liver transplantation.