肝移植术后非吻合口胆道狭窄的介入治疗

Interventional therapy in nonanastomotic biliary strictures after orthotopic liver transplantation

  • 摘要: 目的 探讨肝移植术后非吻合口胆道狭窄的介入治疗方法及其疗效。 方法 回顾性分析2009年1月-2013年12月解放军第309医院共9例肝移植术后发生非吻合口胆道狭窄的临床资料,分别行经腋中线入路和剑突下入路建立2条引流道,行球囊扩张术和胆道引流术。 结果 9例均表现为肝内胆管多发狭窄合并胆泥形成,其中2例合并胆道吻合口狭窄,1例合并胆道吻合口瘘。2例治疗无效,黄疸指数渐进性增高,临床症状和体征未见明显缓解。7例好转,黄疸指数下降,临床症状和体征明显缓解。 结论 反复球囊扩张、分支多次引流、反复胆道塑形是肝移植术后胆道非吻合口狭窄的有效介入治疗方法。

     

    Abstract: Objective To explore the interventional treatment methods in nonanastomotic biliary strictures after orthotopic liver transplantation and observe the effectiveness. Methods Clinical data about 9 cases with nonanastomotic biliary strictures after liver transplantation from January 2009 to December 2013 in the 309th Hospital of Chinese PLA were retrospectively analyzed and balloon dilatation and drainage were performed through axillary midline approach and xiphoid process in 9 cases. Results Of the 9 cases characterized by multiple narrow intrahepatic bile ducts merging with bile mud formation, 2 cases had anastomotic stenosis and 1 case had anastomotic fistula. The treatment in 2 cases was invalid with progressive jaundice index and no obviously alleviated clinical symptoms and signs were found. While, the treatment in the other 7 cases was effective with decreased jaundice index and obviously alleviated clinical symptoms and signs. Conclusion Repeated balloon dilatation, biliary drainage of branches several times and repeated biliary shaping are effective methods for nonanastomotic biliary strictures.

     

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