实用器官移植电子杂志
實用器官移植電子雜誌
실용기관이식전자잡지
Practical Journal of Organ Transplantation (Electronic Version)
2013年
3期
165-168
,共4页
钱晶瑶%李文%董默%石磊
錢晶瑤%李文%董默%石磊
전정요%리문%동묵%석뢰
原位肝移植术%胆漏%胆道并发症%经内镜逆行胆管造影术%经内镜鼻胆管引流术%经内镜胆道内支架置入术%磁共振胰胆管成像术
原位肝移植術%膽漏%膽道併髮癥%經內鏡逆行膽管造影術%經內鏡鼻膽管引流術%經內鏡膽道內支架置入術%磁共振胰膽管成像術
원위간이식술%담루%담도병발증%경내경역행담관조영술%경내경비담관인류술%경내경담도내지가치입술%자공진이담관성상술
Orthotopic liver transplantation%Bile leakage%Biliary complication%Endoscopic retrograde cholangiography%Endoscopic nasobiliary drainage%Endoscopic retrograde biliary drainage%Magnetic resonance cholangiopancreatography
目的探讨经内镜逆行胆管造影术（ERC）在原位肝移植术（OLT）后胆漏中的诊疗作用。方法回顾分析ERC在23例OLT术后胆漏中的诊疗作用，包括胆漏发生时间、胆漏部位、接受ERC诊断治疗过程、治疗效果等临床资料，并评价其诊疗价值。结果本研究共纳入OLT术后胆漏患者23例，其中男性19例，女性4例，平均（49.0±5.8）岁。术前磁共振胰胆管成像术（MRCP）诊断胆漏14例，术中ERC证实胆漏22例均行经内镜鼻胆管引流术（ENBD）和（或）经内镜胆道内支架置入术（ERBD）治疗，18例经内镜治疗好转（其中3例联合腹腔引流，4例联合引流管经T管窦道引流），1例行经皮肝穿胆管引流术（PTCD）；3例再次手术，1例因严重感染死亡。结论 ERC是诊断OLT术后胆漏的有效手段，其敏感性高于MRCP，ERC介入治疗是OLT术后不同类型胆漏的有效治疗手段，但对于存在继发严重感染者预后较差。
目的探討經內鏡逆行膽管造影術（ERC）在原位肝移植術（OLT）後膽漏中的診療作用。方法迴顧分析ERC在23例OLT術後膽漏中的診療作用，包括膽漏髮生時間、膽漏部位、接受ERC診斷治療過程、治療效果等臨床資料，併評價其診療價值。結果本研究共納入OLT術後膽漏患者23例，其中男性19例，女性4例，平均（49.0±5.8）歲。術前磁共振胰膽管成像術（MRCP）診斷膽漏14例，術中ERC證實膽漏22例均行經內鏡鼻膽管引流術（ENBD）和（或）經內鏡膽道內支架置入術（ERBD）治療，18例經內鏡治療好轉（其中3例聯閤腹腔引流，4例聯閤引流管經T管竇道引流），1例行經皮肝穿膽管引流術（PTCD）；3例再次手術，1例因嚴重感染死亡。結論 ERC是診斷OLT術後膽漏的有效手段，其敏感性高于MRCP，ERC介入治療是OLT術後不同類型膽漏的有效治療手段，但對于存在繼髮嚴重感染者預後較差。
목적탐토경내경역행담관조영술（ERC）재원위간이식술（OLT）후담루중적진료작용。방법회고분석ERC재23례OLT술후담루중적진료작용，포괄담루발생시간、담루부위、접수ERC진단치료과정、치료효과등림상자료，병평개기진료개치。결과본연구공납입OLT술후담루환자23례，기중남성19례，녀성4례，평균（49.0±5.8）세。술전자공진이담관성상술（MRCP）진단담루14례，술중ERC증실담루22례균행경내경비담관인류술（ENBD）화（혹）경내경담도내지가치입술（ERBD）치료，18례경내경치료호전（기중3례연합복강인류，4례연합인류관경T관두도인류），1례행경피간천담관인류술（PTCD）；3례재차수술，1례인엄중감염사망。결론 ERC시진단OLT술후담루적유효수단，기민감성고우MRCP，ERC개입치료시OLT술후불동류형담루적유효치료수단，단대우존재계발엄중감염자예후교차。
Objective To discuss the efficacy of endoscopic retrograde cholangiography (ERC)in the diagnosis and management of bile leakage after orthotopic liver transplantation(OLT). Methods From January 2005 to February 2013,23 patients with bile leakage after OLT who were diagnosed by means of magnetic resonance cholangiopancreatography(MRCP)or ERC. The clinical data of 23 cases with bile leakage were reviewed retrospectively,including postoperation time,the location of the bile leakage,times of ERC and whether need bilary stenting,then the clinical value of ERC was evaluated. Results We carried out a retrospective review of 23 consecutive patients with bile leakage after OLT(Male 19,Female 4),the mean age was(49.0±5.8)years old,and one case failed because unsuccessful bile duct cannulation;Therapeutic procedures were carried out in 22 patients, which included endoscopic nasobiliary drainage(ENBD)or endoscopic retrograde biliary drainage(ERBD),cilincal success in 18 patients(three combined with peritoneal drainage,four combined with T-tube fistula drainage), and one drainaged by percutaneous transhepatic drainage(PTCD),three received re-operation,one died because of serious hematosepsis. Conclusions ERC is an effective method for diagnosis of post-OLT bile leakage,its sensitivity and diagnostic accuracy is higher than MRCP and its theraputic effection for different types of bile leakage after OLT is cure. However,the therapeutic effect of ERC was relatively poor for some patients who suffered severe secondary bacterial infection,and whose medical prognosis gets grim.
