肝移植术后胆道结石及胆泥形成原因与诊治

目的探讨肝移植术后胆道结石及胆泥形成的原因及诊治方法。方法回顾性分析我院3例肝移植病人术后发生胆道结石及胆泥的临床资料。结果3例病人发生胆道结石或胆泥间隔时间为3～6个月。诊断主要通过T管造影以及ERCP或MRCP检查发现。1例采取内窥镜介入治疗，1例采取外科手术取石、胆道重建，还有1例则采取再次肝移植。2例成功取石，分别存活1年、2年，1例再次肝移植病人术后死于严重感染。结论肝移植术后发生胆道结石及胆泥主要与缺血一再灌注损伤、胆道冲洗不充分以及胆道供血不足等有关，胆道造影检查有利于及时诊断，放射介入治疗以及外科手术治疗是常用的治疗方法。

Causes, diagnosis and treatment of bilestone and biliary sludge after liver transplantation

Objective To investigate the causes of bilestone and biliary sludge formation after liver transplantation and explore the methods for their diagnosis and treatment. Methods The clinical data of 3 patients with bilestone and biliary sludge after liver transplantation treated in our hospital were retrospectively analyzed. Results The interval between the transplantation and onset of the complications was 3 to 6 months. The diagnosis of the complications was dependent on contrast examination through T tube, ERCP or MRCP. One patient was treated with endoscopic intervention, one with surgical lithotomy and bile duct reconstruction and the other with liver retransplantation. The stones in the former 2 patients were successfully removed and they survived for 1 and 2 years, respectively. The third patient died from severe infection after liver Retransplantation. Conclusions The generation of bilestone and biliary sludge after liver transplantation is mainly due to ischemia reperfusion injury, insufficient bile duct irrigation and insufficient blood supply to the bile duct. Bile duct contrast examination is helpful for correct and timely diagnosis of the complications. Meanwhile, radiological intervention and operation are the common treatments for them.