肝移植术后胆道狭窄的临床特点及治疗效果(附60例报告)

目的 探讨肝移植术后并发胆道狭窄的临床特点及治疗效果.方法 回顾性分析60例肝移植术后胆道狭窄患者的临床资料.并对其临床特点和治疗效果进行了分析和讨论.结果 肝移植术后胆道狭窄的主要症状为胆道梗阻和胆管炎表现.其平均诊断时间为术后(195.5±146.5)d.胆道狭窄早期,肝功能损害主要为血清丙氨酸转氨酶、总胆红素、谷氨酰转肽酶及碱性磷酸酶水平升高,而白蛋白降低;胆道狭窄晚期时,丙氨酸转氨酶水平下降,出现"胆酶分离"现象.经内窥镜逆行胰胆管造影(ERCP)检查发现,胆道狭窄部位为单纯吻合口狭窄6例;肝门部和/或合并吻合口狭窄11例;肝内胆管弥漫性狭窄11例;吻合口合并肝内胆管弥漫性/节段性狭窄32例.其它并发症还包括胆管内有异物、狭窄近端扩张、胆管扭曲及十二指肠乳头旁憩室等.经ERCP介入治疗,取出胆管内异物、坏死组织、结石以及狭窄段球囊扩张等处理后,33例患者治愈,18例好转,9例治疗无效.结论 肝移植术后胆道狭窄的临床表现既有特征性,又有多样性,且合并症较多;采用ERCP介入治疗胆道狭窄效果理想.

Clinical characteristic and effect of biliary stricture following orthotopic liver transplantation(report of 60 eases)

Objective To summarize the clinical manifestation of biliary strictures (BS) in patients after orthotopic liver transplantation (OLT), and to investigate the approach and effect of endoscopic retrograde cholangiography (ERCP) for BS after OLT. Methods The clinical manifestation, findings, therapies and efficacy of 60 patients with BS after OLT were retrospectively analyzed. Results Patients showed symptoms such as jaundice and fever. The average treatment time was (195.5±146.5) days after operation. In the early of BS, liver damage for serum alanine aminotransferase, total bilirubin, glutamyltranspeptidase enzymes and alkaline phosphatase were elevated, and albumin lowered. In the late stage of BS, the level of alanine aminotransferase was decreased and the "gall-separation" occurred. ERCP examination showed there were 6 cases of simple anastomotic stricture, 11 cases of hitar and/or in combination with anastomotie stricture, 1 t cases of diffuse intrahepatic bile duct stenosis, 32 cases of anastomotic stricture combined with intrahepatic bile duct diffuse/segmental stenosis. Other complications included foreign bodies in bile duct, dilation proximal to the stricture, bile duct distort, JPD etc. By ERCP treatment, 33 patients were cured, 18 cases improved, and remaining 9 failed to the treatment. Conclusions After liver transplantation, the incidence of bile duct stricture and complications is high. The bile duct after liver transplantation can be definitely diagnosed and satisfactorily treated by ERCP.