CAJ | 학술논문

目的总结经皮介入技术治疗原位肝移植(OLT)术后胆管吻合口狭窄的经验.方法回顾性分析2004年5月至2009年12月间25例OLT术后胆管吻合口狭窄患者的资料.其中22例行胆道外引流,3例第2次肝移植者行内外引流.25例的治疗方式包括单纯经皮经肝穿刺胆管引流术(PTBD)4例,PTBD配合球囊扩张术14例,PTBD配合胆道支架置入术7例(胆道内涵管5例,胆道金属支架2例).结果 PTBD手术成功率为100%,25例经介入治疗后15例(60%)治愈,10例(40%)好转,有效率达100%.7例首次行PTBD时引流管未能通过胆管狭窄段,其中3例于引流1周后再次调整引流管,成功通过狭窄段,余4例于引流术后4～8周时胆管狭窄段完全闭塞.引流期间发生胆道感染6例(24%),患者均未出现严重手术相关并发症.结论经皮介入技术是治疗OLT术后胆管吻合口狭窄的一种安全、有效的方法.首次PTBD或PTBD后应短期内使引流管尽可能通过狭窄段,以免狭窄处永久闭塞.
목적 총결경피개입기술치료원위간이식(OLT)술후담관문합구협착적경험.방법 회고성분석2004년5월지2009년12월간25례OLT술후담관문합구협착환자적자료.기중22례행담도외인류,3례제2차간이식자행내외인류.25례적치료방식포괄단순경피경간천자담관인류술(PTBD)4례,PTBD배합구낭확장술14례,PTBD배합담도지가치입술7례(담도내함관5례,담도금속지가2례).결과 PTBD수술성공솔위100%,25례경개입치료후15례(60%)치유,10례(40%)호전,유효솔체100%.7례수차행PTBD시인류관미능통과담관협착단,기중3례우인류1주후재차조정인류관,성공통과협착단,여4례우인류술후4～8주시담관협착단완전폐새.인류기간발생담도감염6례(24%),환자균미출현엄중수술상관병발증.결론 경피개입기술시치료OLT술후담관문합구협착적일충안전、유효적방법.수차PTBD혹PTBD후응단기내사인류관진가능통과협착단,이면협착처영구폐새.
Objective To describe the technique, efficacy, and safety of percutaneous interventional therapy for anastomotic biliary strictures after orthotopic liver transplantation (OLT).Methods From May 2004 to December 2009, 25 patients with anastomotic biliary strictures afte OLT were enrolled in our study. The modalities of biliary drainage included external drainage in 22patients, and external-internal drainage in 3 patients who underwent re-transplantation. All patients accepted percutaneous interventional therapy in our hospital, including single PTBD in 4 patients,PTBD combined with balloon dilation in 14 patients, balloon dilation and plastic stent implantation in 5 patients, balloon dilation and metallic stent implantation in 2 patients. The drainage catheters were exchanged every 1 to 3 months. Results The success rate of PTBD was 100%. Of the all 25patients, 15 (60 %) patients were cured, and 10 (40 %) patients were improved. The effective rate was 100 %. The drainage catheters failed to pass through the narrow bile duct when initial PTBD in 7 patients, and success was achieved in 3 patients by operation again after biliary drainage for one week.In the other 4 patients, anastomotic bile ducts were occluded, which was confirmed by cholangiography after biliary drainage for 4 to 8 weeks. The rate of biliary tract infection was 24 % (6/25). No serious procedure-related complications occurred in the all 25 patients. Conclusion PTBD combined with balloon dilation and biliary stenting is a effective and safe therapeutic modality for anastomotic biliary strictures after OLT, which can improve the patients' clinical symptoms and elevate patients' quality of life. To avoid bile duct occlusion, the drainage catheters should be passed through the narrow segments of bile duct when initial PTBD.