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肝移植术后缺血性胆道病变的介入治疗探讨

李名安 黄明声 姜在波 钱结胜 李征然 张有用 庞鹏飞 单鸿

李名安, 黄明声, 姜在波, 等. 肝移植术后缺血性胆道病变的介入治疗探讨[J]. 器官移植, 2015, 6(1): 31-36. doi: 10.3969/j.issn.1674-7445.2015.01.007
引用本文: 李名安, 黄明声, 姜在波, 等. 肝移植术后缺血性胆道病变的介入治疗探讨[J]. 器官移植, 2015, 6(1): 31-36. doi: 10.3969/j.issn.1674-7445.2015.01.007
Li Ming'an, Huang Mingsheng, Jiang Zaibo, et al. Interventional treatment for ischemic-type biliary lesion after liver transplantation[J]. ORGAN TRANSPLANTATION, 2015, 6(1): 31-36. doi: 10.3969/j.issn.1674-7445.2015.01.007
Citation: Li Ming'an, Huang Mingsheng, Jiang Zaibo, et al. Interventional treatment for ischemic-type biliary lesion after liver transplantation[J]. ORGAN TRANSPLANTATION, 2015, 6(1): 31-36. doi: 10.3969/j.issn.1674-7445.2015.01.007

肝移植术后缺血性胆道病变的介入治疗探讨

doi: 10.3969/j.issn.1674-7445.2015.01.007
基金项目: 

广东省科技计划项目 2012B031800085

详细信息
    通讯作者:

    黄明声, Email:gzhuangms@163.com

  • 中图分类号: R617;R445

Interventional treatment for ischemic-type biliary lesion after liver transplantation

More Information
  • 摘要:   目的  探讨肝移植术后缺血性胆道病变(ITBL)患者接受介入治疗的安全性及疗效。  方法  回顾性分析2006年1月至2014年2月在中山大学附属第三医院介入血管科接受介入治疗的76例肝移植术后ITBL患者的影像及临床资料。按胆道造影表现分为3组:肝门区狭窄组(28例), 肝内多发狭窄组(42例), 胆汁瘤组(6例)。治疗方式包括单纯经皮经肝胆管引流术(PTBD)、PTBD配合球囊扩张、PTBD配合球囊扩张及胆道内支架术。引流方式包括胆道外引流及胆道内外引流。术后随访并观察疗效及胆道并发症。  结果  76例患者的PTBD首次成功率为97%(74/76)。介入治疗的总体治愈率、好转率及无效率分别为21%(16/76)、51%(39/76)、28% (21/76)。其中, 肝门区狭窄组治愈10例(36%), 好转16例(57%), 无效2例(7%), 治疗有效22例(93%); 多发性狭窄组治愈6例(14%), 好转21例(50%), 无效15例(36%), 治疗有效27例(64%); 胆汁瘤组好转2例(2/6), 无效4例(4/6)。肝门区狭窄患者的疗效优于多发性狭窄患者(P < 0.05), 多发性狭窄患者的疗效优于胆汁瘤患者(P < 0.001)。引流管期间主要并发症为胆道感染, 其中外引流及内外引流胆道感染发生率分别为20%(13/64)及67%(8/12), 比较差异有统计学意义(P < 0.001)。  结论  PTBD是治疗肝移植术后ITBL的安全、有效手段之一。结合球囊扩张及内支架置入可有效改善患者症状, 提高生存质量。采用胆道外引流可显著降低胆道感染发生率。

     

  • 图  1  部分肝移植术后缺血性胆道病变患者的介入治疗经过

    注:A~D图为1例64岁女性患者(原发性肝癌肝移植术后2个月);A图胆管造影示肝内胆管重度扩张,肝门区胆管及胆管吻合口均可见狭窄(肝门区狭窄组);B图球囊扩张胆管狭窄段后,给予胆道引流治疗;C图:引流管直径逐渐增大至12 F;D图复查示胆管狭窄明显改善,治疗12个月后,给予拔管,达到治愈。E~H图为1例48岁男性患者(乙型病毒性肝炎后肝硬化肝移植术后1年);E图胆管造影示示供肝胆管内多发性狭窄,伴弥漫性胆泥形成(多发性狭窄组);F图给予PTBD治疗,引流管成袢于右侧肝内胆管内;G图引流6个月后患者血清总胆红素基本正常,复查胆管形态改善不明显,植入胆道内涵管2枚(患者无法耐受长期带管);H图置入引流管继续引流1周后给予拔管,随访38个月症状无复发。I~K图为1例31岁男性患者(重型乙型病毒性肝炎肝移植术后1年);I图胆管造影示肝内多发胆汁瘤形成,与肝内胆管沟通,胆管吻合口狭窄(胆汁瘤组);J图给予PTBD治疗,引流3个月后复查胆汁瘤增多,吻合口狭窄改善,患者黄疸症状减轻;K图引流5个月后复查示胆管系统进一步恶化,遂行再次肝移植

    Figure  1.  The procedures of interventional treatments for partial patients with ITBL after liver transplantation

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出版历程
  • 收稿日期:  2014-11-27
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2015-01-15

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