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背景:肝移植后胆道并发症其常见问题,采用经皮经肝胆管引流球囊扩张或单纯经皮经肝胆管引流已成为改善肝移植后胆道并发症的有效方式。目的:通过病例随访评价经皮胆道内球囊扩张及肝胆管引流对原位肝移植后胆管狭窄治疗的有效性。设计、时间及地点:回顾性病例分析,为1999-07/2007-03首都医科大学附属北京朝阳医院放射科接受经皮胆道内治疗的肝移植后胆道并发症患者53例。男46例,女7例,年龄17~64岁。所有患者都因肝移植后血清胆红素水平异常升高,经CT或MRI证实为胆道梗阻。方法:53例中50例患者接受了经皮经肝胆管引流,36例常规通过右侧肝内胆管进行,14例患者接受了双侧(左侧和右侧肝内胆管)肝胆管引流,其中6例是在第2次治疗中对左侧肝内肝管引流;13例同时进行了胆道球囊扩张;3例患者进行了单纯球囊扩张治疗。主要观察指标:对53例患者进行平均9.6个月的随访,观察经皮胆道内干预后血清胆红素水平异常升高致黄疸的控制情况。结果:1例患者带T管治疗随访至1个月时由于急性排斥反应而死亡,1例患者经皮经肝胆管引流随访至1个月时肝功能衰竭自动出院,51例患者到随访结束时黄疸情况均缓解甚至治愈,血清胆红素水平下降甚至正常。一次有效率达79%(42/53),11例患者(21%,11/53)需要多次治疗,其中5例为第一次治疗失败,6例因黄疸复发。治疗与随访过程中未出现与操作相关的严重并发症。结论:原位肝移植后胆道并发症采用经皮经肝胆管引流和球囊扩张治疗安全性较高,未见特殊并发症。
BACKGROUND: Common problems of biliary tract complications after liver transplantation. Percutaneous transhepatic biliary drainage balloon dilation or percutaneous transhepatic bile duct drainage has become an effective way to improve biliary complications after liver transplantation. OBJECTIVE: To assess the effectiveness of percutaneous biliary tract balloon dilatation and hepatobiliary drainage for the treatment of biliary strictures after orthotopic liver transplantation. DESIGN, TIME AND SETTING: The retrospective case analysis was performed on 53 patients with biliary complications after liver transplantation undergoing percutaneous biliary tract surgery from the Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University from July 1999 to March 2007. 46 males and 7 females, aged 17 to 64 years. All patients were abnormally elevated serum bilirubin levels after liver transplantation, confirmed by CT or MRI biliary obstruction. METHODS: Fifty-three of the fifty-three patients underwent percutaneous transhepatic biliary drainage, 36 were routinely performed through the right intrahepatic bile duct, and 14 patients underwent bilateral (left and right intrahepatic bile duct) hepatobiliary drainage with Six patients underwent drainage on the left hepatic duct in the second treatment; 13 patients underwent simultaneous biliary balloon dilatation; and three patients underwent balloon dilation alone. MAIN OUTCOME MEASURES: An average of 9.6 months of follow-up was performed in 53 patients. The control of jaundice was observed after abnormal bilirubin levels were elevated after percutaneous biliary tract intervention. Results: One patient died of acute rejection after 1 month of follow-up of T tube. One patient was discharged automatically after percutaneous transhepatic biliary drainage for 1 month, and 51 patients were discharged at the end of follow-up Jaundice are relieved or even cured, serum bilirubin levels decreased or even normal. With an effective rate of 79% (42/53), 11 patients (21%, 11/53) required multiple treatments, of which 5 were failed for the first treatment and 6 were relapsed due to jaundice. No serious complications related to the operation occurred during the treatment and follow-up. CONCLUSION: Biliary complications after orthotopic liver transplantation are safe to use percutaneous transhepatic biliary drainage and balloon dilation. No special complication has been found.