ERCP诊治成人原位肝移植术后胆道并发症的临床研究

目的 :回顾性分析和评价内镜逆行胰胆管造影(ERCP)在成人原位肝移植胆道并发症诊疗中的作用。方法:38例成人原位肝移植术后胆道并发症患者实施61次ERCP,根据ERCP结果实施内镜治疗。结果:60次ERCP成功,成功率为98.36%(60/61)。ERCP明确胆道并发症原因后实施内镜治疗。并发症发生的部位为:供体肝胆管、受体胆管、胆管吻合口及十二指肠乳头。其中单纯胆管炎性狭窄7例,胆管炎性狭窄伴肝内外胆管铸型、胆泥或胆石形成10例;单纯胆管吻合口狭窄3例,狭窄伴肝内外胆管铸型、胆泥或胆石形成2例;胆管吻合口瘘2例,供体胆管与受体胆管直径差异过大1例;受体胆管过长、扭曲3例,受体胆管轻度扩张1例;十二指肠乳头狭窄2例,Oddi括约肌功能失调3例;T管脱落1例;胆道出血1例;ERCP插管失败1例。该组供体肝胆管并发症发生率最高,为44.74%(17/38);其次为胆管吻合口并发症,为21.05%(8/38)。治疗方式:乳头括约肌切开(EST)24.59%(15/61),乳头柱状球囊扩张(EPBD)16.39%(10/61),EST+EPBD 13.12%(8/61),扩张器扩张胆管36.07%(22/61),鼻胆管引流(ENBD)52.46%(32/61),胆管支架引流(ERBD)32.79%(20/61),取胆管铸型、胆泥或结石19.67%(12/61),胆道冲洗24.59%(15/61)。结论:ERCP具有诊疗一体化优点,已成为成人原位肝移植术后胆道并发症微创治疗的主要方法和重要治疗手段。

Clinic observation and endoscopic therapy in biliary complications of orthotopic liver transplantation

Objective： Retrospective analysis and evaluate endoscopic retrograde cholan- giopancreatography （ERCP） in the diagnostic and therapeutic role of biliary complications after adult orthotopic liver transplantation （BCAOLT）. Methods： 38 cases of BCAOLT with ERCP 61 times were treated correspondingly according to the results of ERCP. Results： 37cases and ERCP 60 times were successful, ERCP success rate was 98.36% （60/61）. The reasons for biliary complica- tions were definite after ERCP. The location of biliary complications as follows： donor liver, donor and receptor bile duct, bile duct anastomotic stoma and duodenal papilla. 7 cases of bile duct stricture with cholangitis; 10 cases of extrahepatic and intrahepatic bile duct stricture with cholangitis, com- bined with biliary cast, biliary sludge formation or bile stones; merely bile duct anastomotic stoma stricture in 3 cases, 2 cases of bile duct anastomotic stoma stricture with chotangitis, combined with biliary cast, biliary sludge formation or bile stones; biliary anastomotic stoma leakage in 2 cases, donor and receptor bile duct diameter was too large difference in 1 case; bile duct was too long and twisted in 3 cases, receptor mild choledochectasia in 1 case; duodenal papillary stenosis in 2 cases, Oddi sphincter dysfunction in 3 cases; T tube falls off 1 case; hemobilia 1 case; ERCP failure 1 case. Donor liver biliary complications incidence rate was the highest in this group, 44.74% （17/38）; fol- lowed by bile duct anastomotic stoma complications, 21.05%（8/38）. The choice of treatment： endo- scopic sphincterotomy （EST） 24.59% （15/61）, endoscopic papillary ballon dilation （EPBD） 16.39% （10/61）, EST＋EPBD 13.12% （8/61）, bile duct expansion 36.07% （22/61）, endoscopic nasobiliary drainage （ENBD） 52.46% （32/61）, endoscopic retrograde biliary drainage （ERBD） 32.79% （20/61）, extraction of biliary cast, biliary sludge formation or choletithiasis 19.67% （12/61）, bile duct irrigation 24.59% ?