CAJ | 학술논문

目的探讨内镜清除肝移植术后肝胆管内坏死物的技术方法及临床意义.方法回顾性分析36例肝移植术后出现肝胆管内坏死物使用胆道镜或十二指肠镜治疗的患者资料,分析治疗前后肝功能等实验室指标的变化情况.结果 36例患者肝胆管坏死物分布为胆总管6例,肝内胆管(包括肝门部胆管)24例,肝内外胆管6例;内镜治疗总有效率72.2％(26/36),16例患者肝胆管内坏死物完全清除,15例得到部分清除,5例无法清除.治疗后患者胆红素、肝转氨酶明显下降,差异有统计学意义(P＜0.05).治疗过程中未发生与内镜治疗相关的严重并发症及死亡病例.36例患者随访时间均在6个月以上,最长84个月.现存活患者17例,其中3例二次肝移植,术后恢复良好;1例因肝功能不稳定仍留置胆管外引流管,必要时给予间断开放引流;余均已无带管,肝功能良好,生活质量良好.19例患者在随访过程中死于胆管相关并发症或其他疾病,其中11例生存4年以上.结论内镜清除肝移植术后肝胆管内坏死物是安全、有效的治疗方法,其微创,可重复,具有良好的临床应用价值.
목적 탐토내경청제간이식술후간담관내배사물적기술방법급림상의의.방법 회고성분석36례간이식술후출현간담관내배사물사용담도경혹십이지장경치료적환자자료,분석치료전후간공능등실험실지표적변화정황.결과 36례환자간담관배사물분포위담총관6례,간내담관(포괄간문부담관)24례,간내외담관6례;내경치료총유효솔72.2％(26/36),16례환자간담관내배사물완전청제,15례득도부분청제,5례무법청제.치료후환자담홍소、간전안매명현하강,차이유통계학의의(P＜0.05).치료과정중미발생여내경치료상관적엄중병발증급사망병례.36례환자수방시간균재6개월이상,최장84개월.현존활환자17례,기중3례이차간이식,술후회복량호;1례인간공능불은정잉류치담관외인류관,필요시급여간단개방인류;여균이무대관,간공능량호,생활질량량호.19례환자재수방과정중사우담관상관병발증혹기타질병,기중11례생존4년이상.결론 내경청제간이식술후간담관내배사물시안전、유효적치료방법,기미창,가중복,구유량호적림상응용개치.
Objective To explore the technological and therapeutic value of endoscope for removal of hepatobiliary necrosis after liver transplantation.Methods Data of 36 patients with suspected hepatobiliary diseases,who underwent choledochoscopy or duodenoscopy to remove necrosis after liver transplantation,were reviewed.Liver function before and after the treatment were compared.Results Hepatobiliary necrosis located in common bile duct (n =6),intrahepatic bile duct (hilar bile duct included) (n =24) and intraand extra-hepatic duct (n =6).The total success rate was 72.2％ (26/36).Full clearance of bile duct necrosis was accomplished in 16 patients,partial clearance in 15 patients and the necrosis could not be removed in 5 others.The serum bilirubin and transaminase decreased significantly,compared with those before endoscopic treatment (P ＜ 0.05).No serious complications or death related to endoscopy occurred during the treatment.After 6-84 month follow-up,in 17 survivals,3 patients underwent a second liver transplantation with good prognosis.All the survivals had a life of good quality with no placed drainage tube except for one with drainage tube for four years with unstable serum bilirubin.Nineteen patients died from biliary tract related complications or other diseases during the long-term follow-up,among which eleven patients survived beyond four years.Conclusion Endoscopy for hepatobiliary necrosis removal,a minimally invasive method,is effective and safe.