中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2014年
8期
577-581
,共5页
汪邵平%郑于剑%李鹏%霍枫
汪邵平%鄭于劍%李鵬%霍楓
왕소평%정우검%리붕%곽풍
肝移植%胆道狭窄,非吻合口%诊断%治疗
肝移植%膽道狹窄,非吻閤口%診斷%治療
간이식%담도협착,비문합구%진단%치료
Liver transplantation%Biliary stricture,non-anastomotic%Diagnosis%Therapy
目的 探讨肝移植术后胆道非吻合口狭窄(NABS)的诊治流程.方法 回顾性分析近10年来我中心肝移植术后发生胆道NABS患者的临床资料,比较NABS的各种诊断和治疗方法,探讨其最佳诊治流程.结果 本中心403例次肝移植患者NABS总体发生率3.2％(13/403),其中心脏死亡供体捐献(DCD)NABS发生率4.16％ (2/48),两者比较差异无统计学意义(P＞0.05).NABS主要表现为胆红素、胆道酶谱升高及反复发作的胆管炎,与对照组(n=20)比较均差异显著(P＜0.01).全部患者经胆道造影确诊,并据此将NABS分为3型:围肝门部狭窄(Ⅰ型,4例);肝门部+肝内胆管狭窄(Ⅱ型,7例);肝内胆管多发狭窄(Ⅲ型,2例).本组NABS患者的治疗主要包括介入微创、胆肠吻合、再次移植3种方法.Ⅰ型患者均通过介入微创和胆肠吻合治愈,但有44.4％ (4/9)的Ⅱ型和Ⅲ型患者需要再移植治疗.再移植后死亡1例,余12例疗效满意,总有效率92.3％(12/13),治疗后随访12例患者胆红素及胆道酶谱均明显下降(P＜0.05).结论 胆道非吻合口狭窄是肝移植术后一种常见的胆道并发症,胆道造影是诊断的金标准.根据胆道造影显现的狭窄类型,遵循从简单到复杂的流程,选择介入微创、胆-肠吻合或再移植手术.Ⅰ型患者相对处理简单,预后最佳,Ⅱ型及Ⅲ型患者若介入微创治疗无效,应及时再次移植.
目的 探討肝移植術後膽道非吻閤口狹窄(NABS)的診治流程.方法 迴顧性分析近10年來我中心肝移植術後髮生膽道NABS患者的臨床資料,比較NABS的各種診斷和治療方法,探討其最佳診治流程.結果 本中心403例次肝移植患者NABS總體髮生率3.2％(13/403),其中心髒死亡供體捐獻(DCD)NABS髮生率4.16％ (2/48),兩者比較差異無統計學意義(P＞0.05).NABS主要錶現為膽紅素、膽道酶譜升高及反複髮作的膽管炎,與對照組(n=20)比較均差異顯著(P＜0.01).全部患者經膽道造影確診,併據此將NABS分為3型:圍肝門部狹窄(Ⅰ型,4例);肝門部+肝內膽管狹窄(Ⅱ型,7例);肝內膽管多髮狹窄(Ⅲ型,2例).本組NABS患者的治療主要包括介入微創、膽腸吻閤、再次移植3種方法.Ⅰ型患者均通過介入微創和膽腸吻閤治愈,但有44.4％ (4/9)的Ⅱ型和Ⅲ型患者需要再移植治療.再移植後死亡1例,餘12例療效滿意,總有效率92.3％(12/13),治療後隨訪12例患者膽紅素及膽道酶譜均明顯下降(P＜0.05).結論 膽道非吻閤口狹窄是肝移植術後一種常見的膽道併髮癥,膽道造影是診斷的金標準.根據膽道造影顯現的狹窄類型,遵循從簡單到複雜的流程,選擇介入微創、膽-腸吻閤或再移植手術.Ⅰ型患者相對處理簡單,預後最佳,Ⅱ型及Ⅲ型患者若介入微創治療無效,應及時再次移植.
목적 탐토간이식술후담도비문합구협착(NABS)적진치류정.방법 회고성분석근10년래아중심간이식술후발생담도NABS환자적림상자료,비교NABS적각충진단화치료방법,탐토기최가진치류정.결과 본중심403례차간이식환자NABS총체발생솔3.2％(13/403),기중심장사망공체연헌(DCD)NABS발생솔4.16％ (2/48),량자비교차이무통계학의의(P＞0.05).NABS주요표현위담홍소、담도매보승고급반복발작적담관염,여대조조(n=20)비교균차이현저(P＜0.01).전부환자경담도조영학진,병거차장NABS분위3형:위간문부협착(Ⅰ형,4례);간문부+간내담관협착(Ⅱ형,7례);간내담관다발협착(Ⅲ형,2례).본조NABS환자적치료주요포괄개입미창、담장문합、재차이식3충방법.Ⅰ형환자균통과개입미창화담장문합치유,단유44.4％ (4/9)적Ⅱ형화Ⅲ형환자수요재이식치료.재이식후사망1례,여12례료효만의,총유효솔92.3％(12/13),치료후수방12례환자담홍소급담도매보균명현하강(P＜0.05).결론 담도비문합구협착시간이식술후일충상견적담도병발증,담도조영시진단적금표준.근거담도조영현현적협착류형,준순종간단도복잡적류정,선택개입미창、담-장문합혹재이식수술.Ⅰ형환자상대처리간단,예후최가,Ⅱ형급Ⅲ형환자약개입미창치료무효,응급시재차이식.
Objective To study the diagnosis and treatment of non-anastomotic biliary stricture (NABS) after liver transplantation.Methods The clinical data of 403 patients who underwent liver transplantation in the past 10 years in our department were analyzed retrospectively,compared different methods to find out the most appropriate method in the diagnosis and management of NABS.Results NABS occurred in 13 out of 403 patients (3.2％),almost the same incidence as in patients who received DCD donor livers (4.16％,2/48).The clinical signs of NABS were frequent cholangitis and high TBil,r-GT and AKP (P ＜0.01).All these cases were finally diagnosed by cholangiography and they could be classified into 3 types:hepatic bile duct stricture (4 patients,type Ⅰ),multiple extrahepatic and intrahepatic biliary strictures (7 patients,type Ⅱ),intrahepatic biliary strictures (2 patients,type Ⅲ).NABS were mainly treated by interventional therapy,Roux-en-Y anastomosis and retransplantation in our centre.All type Ⅰ patients were successfully managed with interventional therapy/ERCP and Roux-en-Y anastomosis,but 44.4％ (4/9) of type Ⅱ and Ⅲ patients required retransplantation.The TBIL,r-GT and AKP decreased significantly in 12 patients (P ＜ 0.05) and the total curative rate of NABS was 92.3％ (12/13) with one patient who died after retransplantation.Conclusions Cholangiography was an effective way to diagnose NABS which is common among patients after liver transplantation.Interventional therapy/ERCP,Roux-en-Y anastomosis and retransplantation were our 3 ways to treat this problem.We proceeded from easy to difficult and chose a suitable way to deal with NABS according to the different types of biliary stricture from cholangiography.Type Ⅰ patients had much better prognosis than Type Ⅱ and Ⅲ patients who should receive retransplantation if interventional therapy/ERCP failed.
