经ERC介入治疗肝移植术后胆管狭窄

目的探讨经ERC介入治疗肝移植术后胆管狭窄的效果。方法收集2005年1月至2007年6月我院收住的肝移植术后胆管狭窄的60例患者的相关资料,归纳分析ERC介入治疗的效果。结果患者就诊的症状主要为胆道梗阻和胆管炎表现。60例胆管狭窄的ERC介入治疗治愈率为55%（33/60）,好转率为30%（18/60）,总有效率为85%（51/60）。吻合口型、肝外型、肝内型及肝内外混合型BS的介入治疗治愈率分别为100%（6/6）、63.6%（7/11）、27.2%（3/11）及53.1%（17/32）。结论肝移植术后胆管狭窄既有特征性表现,又有多样性表现,已成为肝移植术后再次就诊的主要原因,经ERC介入治疗是肝移植术后胆管狭窄的首选。但目前肝移植术后胆管狭窄总体疗效尚不是很理想,治疗效果与其类型密切相关,吻合口型疗效最好,肝外型次之,肝内外混合型和肝内型疗效较差。

ERC INTERVENTIONAL THERAPY OF BILIARY STRICTURE FOLLOWING ORTHOTOPIC LIVER TRANSPLANTATION

Objective To investigate the approach and effect of endoscopic retrograde cholangiography（ERC） for biliary strictures（BS） after orthotopic liver transplantation（OLT） . Methods The treatment and efficacy of 60 patients with BS after OLT from January 2005 to June 2007 were analyzed retrospectively. The patients received interventional therapy through ERC. Results In 60 patients, 46 patients have anastomotic strictures. Over half of patients accompany by cholelithic, bile thrombus,et al. The cure rate of interventional therapy of 60 patients with BS was 55% （33/60）, the improvement rate was 30% （18/60） ,and the total effective rate was 85 % （ 51/60 ）. The cure rate of anastomotic, extrahepatic, intrahepatic, and mixed type was 100% （ 6/6 ） ,63.6% （ 7/11 ）, 27. 2 % （3/11） and 53.1% （17/32） respectively. Conclusion The appearance of BS after OLT shows not only characteristics but also multiformity. Biliary balloon dilation , stent or bile drainage through ERC are effective therapeutic approach for BS after OLT. The therapeutic of interventional therapy of BS is related to its type. The therapeutic efficacy of anastomotic BS is the best, followed by extrahepatic BS,mixed BS and intrahepatic BS.