CAJ | 학술논문

目的探讨胆道镜下氩气刀(APC)治疗肝移植术后胆道并发症的临床应用价值.方法肝移植术后胆道并发症患者27例经T管窦道胆道镜或经皮经肝胆道镜(PTCS)途径使用APC治疗肝移植术后相关胆道并发症.胆管狭窄经APC凝切增生组织后配合探条扩张;胆管异物经APC凝切后清除;胆管息肉样肉芽先行肉芽组织活检,之后凝切;吻合口缝线经APC凝切后取出.结果 25例28处胆管狭窄的治疗成功率为78.6%(22/28);7例胆管异物的清除率为85.7%(6/7);5例胆管息肉样肉芽的病理检查结果均为良性增生或炎性肉芽,APC清除率为100%;5例胆管吻合口缝线的APC凝切取出率为100%.无APC治疗相关并发症发生.胆管狭窄术后3个月复发率为4.5%(1/22),术后6个月累计复发率为13.6%(3/22),均为非吻合口狭窄.胆管异物术后3个月复发率为16.7%(1/6),术后6个月累计复发率为33.3%(2/6).结论胆道镜下使用APC治疗肝移植术后胆管狭窄、胆管异物、胆管息肉样肉芽和处理吻合口缝线的成功率较高.
목적 탐토담도경하아기도(APC)치료간이식술후담도병발증적림상응용개치.방법 간이식술후담도병발증환자27례경T관두도담도경혹경피경간담도경(PTCS)도경사용APC치료간이식술후상관담도병발증.담관협착경APC응절증생조직후배합탐조확장;담관이물경APC응절후청제;담관식육양육아선행육아조직활검,지후응절;문합구봉선경APC응절후취출.결과 25례28처담관협착적치료성공솔위78.6%(22/28);7례담관이물적청제솔위85.7%(6/7);5례담관식육양육아적병리검사결과균위량성증생혹염성육아,APC청제솔위100%;5례담관문합구봉선적APC응절취출솔위100%.무APC치료상관병발증발생.담관협착술후3개월복발솔위4.5%(1/22),술후6개월루계복발솔위13.6%(3/22),균위비문합구협착.담관이물술후3개월복발솔위16.7%(1/6),술후6개월루계복발솔위33.3%(2/6).결론 담도경하사용APC치료간이식술후담관협착、담관이물、담관식육양육아화처리문합구봉선적성공솔교고.
Objective To investigate the clinical value of argon plasma coagulation (APC)trans-choledochoscopy in biliary tract complications following liver transplantation. Methods All 27 patients underwent T-tube-choledochoscopy or percutaneous transhepatic cholangioscope (PTCS).APC was used to burn the hyperplasia of bile duct stenosis and then expended the stenosis with bougienage. The bile duct foreign bodies were burnt by APC and then eliminated. The granulation tissues of bile duct were burnt by APC after biopsied. The sutures of anastomoses were burnt by APC and then eliminated. Results In general, the therapeutic achievement ratio of stenosis of bile duct in 25 cases of 28 locations was 78. 6% (22/28). The clearance ratio of bile duct foreign bodies was 85. 7% (6/7). The elimination ratio of granulation tissues was 100% (5/5), the same as the elimination ratio of sutures of anastomoses. There were no treatment-related complications about APC. The recurrence ratio of bile duct stenosis was respectively 4.5% (1/22) and 13. 6% (3/22)after follow-up for 3 and 6 months respectively. All the recurrent stenosis was non-anastomotic. The recurrence ratio of bile duct foreign bodies was respectively 16. 7% (1/6) and 33.3% (2/6) after follow-up for 3 and 6 months respectively. Conclusion APC trans-choledochoscopy in treatment of biliary anastomotic stenosis, mural foreign bodies, mural biliary cast, granulation tissues of bile duct and sutures of anastomoses following liver transplantion has a high success ratio and a sure long-term efficacy without treatment-related complications.