中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2015年
3期
156-160
,共5页
杨玉龙%张诚%马跃峰%吴萍%林美举%张洪威%史力军%李婧伊%杨士明
楊玉龍%張誠%馬躍峰%吳萍%林美舉%張洪威%史力軍%李婧伊%楊士明
양옥룡%장성%마약봉%오평%림미거%장홍위%사력군%리청이%양사명
肝移植%吻合口%胆管%胰胆管造影术,内窥镜逆行
肝移植%吻閤口%膽管%胰膽管造影術,內窺鏡逆行
간이식%문합구%담관%이담관조영술,내규경역행
Liver transplantation%Stomas%Bile ducts%Cholangiopancreatography,dndoscopic retrograde
目的 探讨肝移植术后胆管吻合口狭窄的分型及其临床价值.方法 回顾性分析24例肝移植术后胆道造影诊断为吻合口狭窄患者的临床资料,采取胆道镜及十二指肠镜进行观察及治疗,联合胆道造影及胆道内镜对吻合口狭窄进行分型.结果 经T型管胆道造影诊断吻合口狭窄共17例.17例中,2例胆道镜示吻合口无狭窄,实为肝外胆管铸型1例(Ⅰa型)及肝内外胆管铸型1例(Ⅰb型);单纯性吻合口狭窄2例,无胆管铸型(Ⅱ型);肝内和(或)外胆管铸型合并吻合口狭窄13例(Ⅲ型),其中肝外胆管铸型合并吻合口狭窄1例(Ⅲa型),肝内胆管铸型合并吻合口狭窄4例(Ⅲb型),肝内外胆管铸型合并吻合口狭窄8例(Ⅲc型).17例中,Ⅰ型患者经胆道镜取出铸型后观察吻合口黏膜移行良好,黏膜轻度水肿;Ⅱ型患者经球囊扩张及塑料支架支撑2个月后狭窄解除;Ⅲ型患者胆道镜取净胆管铸型后,吻合口有不同程度的狭窄,黏膜充血水肿,球囊扩张及塑料支架支撑3～6个月后狭窄解除,镜下观察狭窄消失,黏膜移行佳.胆道镜治疗术后未出现胆道系统感染、出血、胆漏等并发症.经内镜逆行胰胆管造影术(ERCP)诊断吻合口狭窄共7例,其中Ⅰa型2例,Ⅰb型1例,Ⅱ型2例,Ⅲb型1例,Ⅲc型1例.Ⅰa型患者经ERCP取出铸型后狭窄解除,Ⅰb型患者行经皮经肝胆道引流术及经皮经肝胆道内镜检查术取出铸型后狭窄解除,Ⅱ型患者经球囊扩张及塑料支架支撑3个月后狭窄解除.ERCP后出现高淀粉酶血症1例、胆道系统感染3例,其中1例Ⅲb型及1例Ⅲ℃型术后反复出现发热及黄疸症状,采取开腹手术及胆道镜技术而治愈.随访2～161个月,1例Ⅱ型患者于狭窄解除后1个月复发,1例Ⅰa型及Ⅰb型患者分别于铸型取出后5个月、19个月发展为Ⅱ型吻合口狭窄,分别行内镜逆行多枚塑料支架置入,4～6个月后狭窄未解除,采取覆膜可回收金属支架支撑4～7个月后狭窄解除.结论 肝移植术后吻合口狭窄可以分为3种型及5种亚型,此种分型有利于肝移植术后吻合口狭窄的规范化治疗.
目的 探討肝移植術後膽管吻閤口狹窄的分型及其臨床價值.方法 迴顧性分析24例肝移植術後膽道造影診斷為吻閤口狹窄患者的臨床資料,採取膽道鏡及十二指腸鏡進行觀察及治療,聯閤膽道造影及膽道內鏡對吻閤口狹窄進行分型.結果 經T型管膽道造影診斷吻閤口狹窄共17例.17例中,2例膽道鏡示吻閤口無狹窄,實為肝外膽管鑄型1例(Ⅰa型)及肝內外膽管鑄型1例(Ⅰb型);單純性吻閤口狹窄2例,無膽管鑄型(Ⅱ型);肝內和(或)外膽管鑄型閤併吻閤口狹窄13例(Ⅲ型),其中肝外膽管鑄型閤併吻閤口狹窄1例(Ⅲa型),肝內膽管鑄型閤併吻閤口狹窄4例(Ⅲb型),肝內外膽管鑄型閤併吻閤口狹窄8例(Ⅲc型).17例中,Ⅰ型患者經膽道鏡取齣鑄型後觀察吻閤口黏膜移行良好,黏膜輕度水腫;Ⅱ型患者經毬囊擴張及塑料支架支撐2箇月後狹窄解除;Ⅲ型患者膽道鏡取淨膽管鑄型後,吻閤口有不同程度的狹窄,黏膜充血水腫,毬囊擴張及塑料支架支撐3～6箇月後狹窄解除,鏡下觀察狹窄消失,黏膜移行佳.膽道鏡治療術後未齣現膽道繫統感染、齣血、膽漏等併髮癥.經內鏡逆行胰膽管造影術(ERCP)診斷吻閤口狹窄共7例,其中Ⅰa型2例,Ⅰb型1例,Ⅱ型2例,Ⅲb型1例,Ⅲc型1例.Ⅰa型患者經ERCP取齣鑄型後狹窄解除,Ⅰb型患者行經皮經肝膽道引流術及經皮經肝膽道內鏡檢查術取齣鑄型後狹窄解除,Ⅱ型患者經毬囊擴張及塑料支架支撐3箇月後狹窄解除.ERCP後齣現高澱粉酶血癥1例、膽道繫統感染3例,其中1例Ⅲb型及1例Ⅲ℃型術後反複齣現髮熱及黃疸癥狀,採取開腹手術及膽道鏡技術而治愈.隨訪2～161箇月,1例Ⅱ型患者于狹窄解除後1箇月複髮,1例Ⅰa型及Ⅰb型患者分彆于鑄型取齣後5箇月、19箇月髮展為Ⅱ型吻閤口狹窄,分彆行內鏡逆行多枚塑料支架置入,4～6箇月後狹窄未解除,採取覆膜可迴收金屬支架支撐4～7箇月後狹窄解除.結論 肝移植術後吻閤口狹窄可以分為3種型及5種亞型,此種分型有利于肝移植術後吻閤口狹窄的規範化治療.
목적 탐토간이식술후담관문합구협착적분형급기림상개치.방법 회고성분석24례간이식술후담도조영진단위문합구협착환자적림상자료,채취담도경급십이지장경진행관찰급치료,연합담도조영급담도내경대문합구협착진행분형.결과 경T형관담도조영진단문합구협착공17례.17례중,2례담도경시문합구무협착,실위간외담관주형1례(Ⅰa형)급간내외담관주형1례(Ⅰb형);단순성문합구협착2례,무담관주형(Ⅱ형);간내화(혹)외담관주형합병문합구협착13례(Ⅲ형),기중간외담관주형합병문합구협착1례(Ⅲa형),간내담관주형합병문합구협착4례(Ⅲb형),간내외담관주형합병문합구협착8례(Ⅲc형).17례중,Ⅰ형환자경담도경취출주형후관찰문합구점막이행량호,점막경도수종;Ⅱ형환자경구낭확장급소료지가지탱2개월후협착해제;Ⅲ형환자담도경취정담관주형후,문합구유불동정도적협착,점막충혈수종,구낭확장급소료지가지탱3～6개월후협착해제,경하관찰협착소실,점막이행가.담도경치료술후미출현담도계통감염、출혈、담루등병발증.경내경역행이담관조영술(ERCP)진단문합구협착공7례,기중Ⅰa형2례,Ⅰb형1례,Ⅱ형2례,Ⅲb형1례,Ⅲc형1례.Ⅰa형환자경ERCP취출주형후협착해제,Ⅰb형환자행경피경간담도인류술급경피경간담도내경검사술취출주형후협착해제,Ⅱ형환자경구낭확장급소료지가지탱3개월후협착해제.ERCP후출현고정분매혈증1례、담도계통감염3례,기중1례Ⅲb형급1례Ⅲ℃형술후반복출현발열급황달증상,채취개복수술급담도경기술이치유.수방2～161개월,1례Ⅱ형환자우협착해제후1개월복발,1례Ⅰa형급Ⅰb형환자분별우주형취출후5개월、19개월발전위Ⅱ형문합구협착,분별행내경역행다매소료지가치입,4～6개월후협착미해제,채취복막가회수금속지가지탱4～7개월후협착해제.결론 간이식술후문합구협착가이분위3충형급5충아형,차충분형유리우간이식술후문합구협착적규범화치료.
Objective To explore the types of biliary anastomotic strictures after liver transplantation and discuss the clinical value.Method Twenty-four cases of bile duct anastomotic strictures after liver transplantation diagnosed by cholangiography were analyzed.The choledochoscopy and duodenoscopy were used for observation and treatment.The types of biliary anastomotic strictures were confirmed by a combination of choledochoscopy,duodenoscopy,and cholangiography.Result Seventeen cases were diagnosed as biliary anastomotic strictures by T tube cholangiography:one case of type Ⅰ a with simple extrahepatic biliary cast,one case of type Ⅰ b with intrahepatic and extrahepatic biliary casts,two cases of type Ⅱ with simple anastomotic strictures,one case of type Ⅲa with extrahepatic biliary casts and anastomotic stricture,four cases of type Ⅲ b with intrahepatic biliary casts and anastomotic strictures,and eight cases of type Ⅲ c with intrahepatic and extrahepatic biliary casts and anastomotic strictures.The anastomotic strictures of type Ⅰ were relieved by removing the biliary casts,type Ⅱ by balloon dilatation and plastic stenting for two months,and type Ⅲ by removing the biliary casts,balloon dilatation and plastic stenting for three to six months.There were no postoperative biliary infection,bleeding,bile leakage and other complications after choledochoscopic treatment.Seven cases were diagnosed as biliary anastomotic strictures by endoscopic retrograde cholangiopancreatonraphy (ERCP) including one case of type Ⅰ a,one case of type Ⅰ b,two cases of type Ⅱ,one case of type Ⅲ b and one case of type Ⅲ c.The anastomotic strictures of type Ⅰ a were relieved by ERCP to clear the biliary casts,type Ⅰ b by percutaneous transhepatic catheter drainage (PTCD) and percutaneous transhepatic cholangioscopy (PTCS),and type Ⅱ by balloon dilatation and plastic stenting for 3 months.There was one case of postoperative hyperamylasemia and three cases of biliary infection after ERCP,including one case of type Ⅲa and one case of type Ⅲ c which received a second open operation to remove the residual biliary casts by choledochoscopy,and the anastomotic strictures relieved by balloon dilatation and plastic stenting for 3 to 6 months.During the follow-up period of 2 to 161 months,1 case of typeⅡ relapsed in the following one month.A case of type Ⅰ a and a case of Ⅰ b developed into strictures of type Ⅱ in the following 5 months and 19 months,respectively.The strictures were not relieved by multiple plastic stents for 4 to 6 months in the three recidivists of type Ⅱ,but relieved by fully covered selfexpanding removable metal stents (FCSERMS) for 4 to 7 months.Conclusion Bile duct anastomotic strictures after liver transplantation can be divided into three types and five subtypes,which is beneficial for the standardized treatment of biliary anastomotic strictures after liver transplantation.
