原位肝脏移植术后胆道狭窄的病因分析与治疗方法

目的 探讨原位肝移植术后胆道狭窄的病因及治疗方法.方法 回顾性分析2006年5月至2008年9月间90例肝移植受者的临床资料,对术后发生胆道狭窄的病因和治疗方法进行了探讨.结果 90例肝移植受者中,术后有8例发生胆道狭窄并发症(8.89%),其中吻合口狭窄5例,非吻合口狭窄3例.吻合口狭窄中,有3例因炎症水肿引起狭窄,经内镜逆行胆管造影(ERC)球囊扩张或置入胆道支架治疗后痊愈;另2例因吻合口胆漏疤痕收缩导致狭窄,经ERC置入胆道塑料支架,1例狭窄消失,1例好转.3例非吻合口狭窄者,均为弥漫性肝内胆管狭窄,经ERC或经皮肝穿刺胆道造影(PTC),采用球囊扩张和胆道支架置入治疗效果不佳,2例行二次肝脏移植后获救,1例治疗无效死亡.结论 吻合口狭窄和非吻合口狭窄的病因对治疗的反应存在差异,因此,要重视肝移植术后胆道狭窄的病因诊断和分析.只要及时采取适当的治疗措施,均可有效地治疗肝移植术后胆道狭窄.

Analysis of the causes and treatment of biliary stricture after orthotopic liver transplantation

Objective To explore the causes and treatment of biliary stricture after orthotopic liver transplantation (OLT). Methods The clinical data of 90 patients receiving liver transplantation between May 2006 and September 2008 were retrospectively analyzed. Results There were 8 cases of biliary stricture in 90 cases (8.89 %). There were 5 cases of anastomotic biliary stricture (ABS), and 3 cases of non-anastomotic biliary stricture (NABS). Among the patients with ABS, they were subjected to sacculus dilatation and stent through ERCP. Four patients were cured, and 1 improved. Among the patients with NABS, 2 cases received second liver transplantation and cured, and 1 died. Conclusions The distinct between NABS and ABS is important, as their pathology, response to treatment, and outcomes, are different. The biliary strictures after OLT will be effectively prevented and reduced through early diagnosis and reasonable treatment.