经皮肝穿刺胆道引流介入治疗肝移植术后胆道狭窄30例

目的 探讨经皮肝穿刺胆道引流介入治疗原位肝移植术后胆道狭窄的可行性及其效果.方法 对292例原位肝移植术后出现胆道狭窄的30例患者分别行胆道球囊扩张术、胆道引流术和胆道支架置入术.结果 3例胆道狭窄合并胆瘘患者和3例单纯吻合口狭窄患者,经气囊扩张术和胆道引流后痊愈.8例肝内外胆管多发狭窄患者,经气囊反复扩张胆道狭窄段后,7例狭窄纠正而获得痊愈;1例经气囊扩张治疗后出现肝内血肿,再次行肝移植.14例肝内外胆管多发狭窄合并胆泥的患者,经反复球囊导管扩张后,12例狭窄明显减轻,黄疸缓解;1例置入胆道支架,后因大量胆泥造成支架阻塞而再次行肝移植;1例治疗后狭窄仍存在,黄疸无缓解而再次行肝移植.2例T型管引流口段狭窄行经皮肝穿刺胆道引流术后,狭窄明显减轻,黄疸缓解.结论 经皮肝穿刺胆道引流介入是治疗原位肝移植术后胆道狭窄的良好方法.

Interventional therapy of biliary tract stricture by percutaneous transhepatic biliary tract drainage after orthotopic liver transplantation in 30 cases

Objective To discuss feasibility and therapeutic effect of the interventional management through biliary tract drainage with percutaneous transhepatic puncture technique for biliary tract stricture after orthotopic liver transplantation. Methods A retrospective review of the clinical and imaging materials of 292 postoperative orthotopic liver transplantation cases was made. Of these 292 cases, 30 patients suffered from biliary tract complications and treated with billiary balloon dilatation, bile drainage and biliary stenting techniques. Results After biliary balloon dilatation, 3 cases of biliary tract strictures and leaks, 3 cases of simple biliary anastomosis site strictures and 7 out of the 8 cases of multiple biliary tract strictures were cured. In one of the multiple biliary tract stricture patients, a hepatic hematoma after biliary balloon dilatation was found and a second liver transplantation was done. In the 14 cases of multiple biliary tract strictures accompanied with biliary sludge, balloon dilatation technique was repeatedly performed. In 12 of the 14 cases, the strictures were improved remarkably and jaundice was subsided; In one of 14 cases, biliary tract stenting procedure was performed, but liver re-transplatation was carried out because of stent obstruction by much sludge. In the remaining 1 of the 14 cases, because there was no improvement of the strictures and relief of jaundice was revealed after the repeated procedures, liver re-transplantation was finally done In 2 cases of strictures at the opening segment of the T tube, the procedure of percutaneous transhepatic puncture for bile drainage was managed. After the procedure, the strictures were alleviated and the jaundice relieved. Conclusion The interventional managements through percutaneous transhepatic puncture techniques were effective, convenient and minimally invasive for treating biliary tract strictures after orthotopic liver transplantation.