【摘要】 目的探讨原位肝移植术后肝动脉狭窄导致缺血型胆管损伤的治疗方法及预后。方法回顾性分析我院2004年6月至2008年6月,11例肝移植术后肝动脉狭窄导致胆管损伤,接受肝动脉支架成形联合内镜逆行胰胆管造影术(ERCP)和(或)经皮经肝胆管引流(PTCD)处理患者的临床资料。结果11例患者成功植入12枚冠脉支架,5例单独采用胆道ERCP引流,3例采用PTCD,3例ERCP疗效欠佳后改用PTCD。随访4个月至4年,6例死于感染,其中5例1年内死亡,3例再次接受移植,2例生存至今。结论肝移植术后肝动脉狭窄导致缺血型胆管损伤总体疗效欠佳。肝动脉支架联合胆道长期引流可延长移植物存活期,为再次肝移植提供机会。更多还原

【Abstract】 Objective To discuss the treatment of ischemic-type biliary injury due to hepatic artery stricture after orthotopic liver transplantation and to estimate its prognosis. Methods The clinical data of 11 patients with ischemic-type biliary injury due to hepatic artery stricture after orthotopic liver transplantation encountered during the period of June 2004 ～ June 2008, who underwent hepatic artery stenting together with endoscopic retrograde cholangiopancreatography (ERCP) and / or percutaneous transhepatic cholangial drainage (PTCD), were retrospectively analyzed. Results A total of 12 balloon-expandable coronary stents was successfully implanted in 11 patients. In 5 patients only ERCP was adopted and in 3 patients only PTCD was used. The remaining 3 patients received PTCD after they failed to respond to ERCP. During a follow-up period of 4 months ～ 4 years, 6 cases died of infection, of which 5 died within one year. Three patients accepted liver transplantation once more. The other 2 patients survived so far. Conclusion The overall therapeutic result of ischemic-type biliary injury due to hepatic artery stricture after orthotopic liver transplantation is not ideal at present. Hepatic artery stenting combined with longstanding PTCD may prolong the survival time of the grafted liver and, therefore, provide opportunity for re-transplantation.更多还原