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目的探讨原位肝移植术后非吻合口胆管狭窄(NABS)的预防和治疗措施。方法对2004年1月至2006年12月中山大学附属第一医院收治的516例同种原位肝移植病人的临床资料进行回顾性分析。总结肝移植术后发生NABS的情况。结果共发生NABS18例(3.5%),其中肝门部胆管狭窄9例,肝内胆管多发狭窄6例,肝内外胆管多发狭窄3例。18例病人采用给予反复的介入、内镜治疗、外科重建胆道及再次肝移植治疗。该组近期临床治愈率为55.6%(10/18),与NABS相关的再次肝移植率为38.9%(7/18),与NABS相关病死率为22.2%(4/18)。结论肝移植术后发生NABS临床处理棘手,应注重预防。NABS的治疗主要包括介入治疗和手术治疗,其中胆管介入治疗在NABS的临床处理中仍占重要地位,对于介入治疗、外科手术重建胆道等措施均无法控制其进行性发展的重度NABS病人,应把握好时机行再次肝移植。

Prevention and management of non-anastomotic biliary stricture after liver transplantation

Objective To investigate the prevention and management of non-anastomotic biliary stricture (NABS) after orthotopic liver transplantation.Methods The clinical data of 516 patients underwent orthotopic liver transplantation from January 2004 to December 2006 at the First Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively.The incidence and course of NABS after liver transplantation were summarized.Results NABS occurred in 18 patients (3.5%).Among them,9 patients had biliary strictures at the site of hepatic bile duct bifurcation,and 6 patients had intrahepatic biliary strictures,and 3 patients had multiple extrahepatic and intrahepatic biliary strictures.Eighteen patients with NABS were managed with interventional therapy,endoscopic treatment,Roux-en-Y anastomosis or retransplantation.The short-term curative rate was 55.6% (10/18).The incidence of NABS-related retransplantation was 38.9% (7/18),and the NABS-related mortality was 22.2%(4/18).Conclusion It is very complicated to manage NABS after liver transplantation.Therefore more attention should be paid to its prevention.The management of NABS mainly includes interventional therapy and surgery,among which interventional therapy is a important treatment.To the patients who failed interventional therapy and surgery, retransplantaiton is indicated.