【摘要】 背景:肝移植术后胆管狭窄主要是胆管吻合口的狭窄,介入球囊扩张只能暂时通畅胆道,没有根本解决问题。目的:观察应用胆道内镜技术诊断和治疗原位肝移植后胆管狭窄的效果。设计、时间及地点:病例分析,于2001-07/2005-10在大连市肝胆外科研究所,大连市友谊医院肝胆外科住院患者10例,天津第一中心医院器官移植科住院患者4例均在行原位肝移植术后发生胆管狭窄。对象:纳入14例中男10例,女4例,平均年龄46岁,肝移植术均采用供、受者胆管端-端吻合。方法:对14例原位肝移植术后发生胆管狭窄的病例进行胆道内镜的诊断和分析,同时采用胆道镜下球囊扩张后支撑管方法治疗肝移植后胆道狭窄。主要观察指标:T管造影、内镜下肝内外胆管黏膜直观:结石的分布、吻合口胆管黏膜的;供-受体胆管吻合口的愈合情况:炎症水肿的情况、狭窄;经内镜取石、狭窄扩张治疗后上述指标的复查。结果:①胆管狭窄的诊断:经胆道造影和内镜诊断胆管吻合口狭窄13例,其中1例是结石导致的狭窄假象;非吻合口狭窄1例。②胆管狭窄的治疗:通过胆道造影明确的吻合口狭窄中,1例采取球囊扩张1次治愈,2例行经内镜十二指肠乳头括约肌切开术+网篮取石+鼻胆引流术后仍然发生胆系感染和黄疸而行手术以及纤维胆道镜治疗。通过T型管造影,1例发现条状负影,无狭窄,纤维胆道镜观察胆管吻合口愈合佳,黏膜移行良好;2例肝内显影差或不显影而呈胆管消失改变,纤维胆道镜取净结石后,扩张吻合口的狭窄后支撑三四个月后狭窄消失,黏膜移行良好。8例肝内外胆管显影模糊,肝外和肝内Ⅰ、Ⅱ级胆管有条索状、柱状、树枝状负影和非吻合性狭窄征象,纤维胆道镜观察取净结石后观察吻合口处均有不同程度的狭窄、充血水肿,扩张支撑平均2.5个月后,狭窄消失,黏膜移行佳。1例造影提示吻合口狭窄,狭窄扩张后,内镜观察未发现结石,支撑2个月后拔管治愈。结论:胆道内镜可直观原位肝移植术后胆管狭窄的情况,进行可靠的诊断,并有效完成支撑管扩张治疗胆管狭窄。更多还原

【Abstract】 BACKGROUND:Biliary stricture following liver transplantation is mainly focus on biliary stoma stricture; while, balloon dilatation temporarily keeps biliary tract open but not works out a solution at all. OBJECTIVE: To discuss the diagnosis and treatment of postoperative biliary stricture after orthotopic liver transplantation by the endoscope technique. DESIGN, TIME AND SETTING: A case analysis, which was performed at Dalian Liver and Gall Surgical Institute. Ten patients hospitalized from the Department of Liver and Gall Surgery of Dalian Friendship Hospital and four patients hospitalized from the Department of Organ Transplantation of Tianjin First Central Hospital were diagnosed as biliary stricture after orthotopic liver transplantation. PARTICIPANTS: Among 14 patients, 10 males and 4 females with mean age of 46 years provided end-to-end biliary anastomose. METHODS: Fourteen cases of postoperative biliary stricture after orthotopic liver transplantation were analyzed and diagnosed by endoscope technique. And by endoscope technique, the stricture was supported with tube after balloon dilatation. MAIN OUTCOME MEASURES: Bile duct mucous membrane under T-tube radiography and endoscope; calculary distribution and bile duct mucous membrane at stoma; healing of biliary stoma of donors and recipients; inflammatory edema and stricture; recheck of above-mentioned parameters after stricture expansion by endoscopic stone extraction technique. RESULTS: Thirteen cases of postoperative biliary stricture after orthotopic liver transplantation were analyzed and diagnosed by endoscope technique, including one was induced by calculus, and one non-stoma stricture. One case was treated with balloon dilation; biliary infection and jaundice occurred in 2 cases after endoscopic sphincterotomy (EST) + basket lithotripsy + endoscopic nasobiliary drainage (ENBD), so operations or fibrocholedochoscope treatments had to be carried out. By T tube radiography, in 1 case there was strip-like negative simulacrum or no stricture, well-healed anastomosis and good mucous membranel transition; poor or no intrahepatic visualization were found in 2 cases, so anastomosis dilation was processed after the calculi removal by fibrocholedochoscope, stricture disappeared in 3 or 4 months; in 8 cases there were blur extrahepatic or intrahepatic biliary visualization, cord-like, column or branch-like negative simulacrum in biliary ducts and sign of non-anastomosis stricture, after removal of calculi, anastomosis stricture and congestion, edema were found, all these disappeared after average 2.5 months of dilation; the other 1 case was found stricture by T the radiography, but no calculi was found with fibrocholedochoscope, finally the T tube was removed after 2 months of stricture dilation. CONCLUSION: Endoscopy is significant to directly reflect and reliably diagnose postoperative biliary stricture and effectively treat biliary stricture by anastomosis dilation.更多还原