赵东, 张卓, 黄一鸣, 等. SpyGlass直视系统在肝移植术后胆道狭窄诊治中的初步探索[J]. 器官移植, 2022, 13(1): 55-60. DOI: 10.3969/j.issn.1674-7445.2022.01.009
引用本文: 赵东, 张卓, 黄一鸣, 等. SpyGlass直视系统在肝移植术后胆道狭窄诊治中的初步探索[J]. 器官移植, 2022, 13(1): 55-60. DOI: 10.3969/j.issn.1674-7445.2022.01.009
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Zhao Dong, Zhang Zhuo, Huang Yiming, et al. Preliminary exploration of SpyGlass direct visualization system in diagnosis and treatment of biliary stricture after liver transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(1): 55-60. DOI: 10.3969/j.issn.1674-7445.2022.01.009
Citation: Zhao Dong, Zhang Zhuo, Huang Yiming, et al. Preliminary exploration of SpyGlass direct visualization system in diagnosis and treatment of biliary stricture after liver transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(1): 55-60. DOI: 10.3969/j.issn.1674-7445.2022.01.009
shu

SpyGlass直视系统在肝移植术后胆道狭窄诊治中的初步探索

Preliminary exploration of SpyGlass direct visualization system in diagnosis and treatment of biliary stricture after liver transplantation

    摘要
  • 摘要:
      目的  初步探讨SpyGlass直视系统在肝移植术后胆道狭窄诊治中的应用价值。
      方法  收集4例因肝移植术后胆道狭窄接受SpyGlass直视系统检查患者的临床资料，分析其针对胆道狭窄的检查、治疗手段及相关预后。
      结果  4例患者的彩色多普勒超声、磁共振胰胆管成像(MRCP)及内镜逆行胰胆管成像(ERCP)检查结果均提示胆道吻合口狭窄合并肝内胆道扩张，其中2例伴肝内胆道结石，3例在ERCP下反复多次放置胆道支架效果欠佳。SpyGlass直视系统检查结果提示胆道吻合口狭窄者4例，肝内胆道扩张者3例，肝内胆道结石者3例，胆汁呈脓性者2例，胆道有絮状物者3例；胆道壁充血水肿者1例，肝内胆道壁局部上皮坏死、僵硬改变者2例；1例患者由于胆道吻合口狭窄严重，导丝无法通过。4例患者分别接受胆道狭窄段切除+胆道结石取出+胆道端端吻合术、胆道狭窄段切除+胆肠吻合术、ERCP取石+胆道金属支架植入术和胆道金属支架植入术+经皮经肝穿刺胆管取石术进行治疗，病情均得到缓解，均未出现明显并发症，随访至投稿日，患者均存活。
      结论  与传统影像学检查比较，SpyGlass直视系统可更加直观地显示胆道壁的形态学特征及胆道腔内的结构变化，是肝移植术后胆道狭窄的一种有效检查手段，并能针对不同胆道病变采取个体化治疗方式，有望改善患者预后。

     

    Abstract:
      Objective  To preliminarily evaluate the application value of SpyGlass direct visualization system in the diagnosis and treatment of biliary stricture after liver transplantation.
      Methods  Clinical data of 4 patients presenting with biliary stricture after liver transplantation who underwent SpyGlass direct visualization system examination were collected. The examination, treatment and prognosis of biliary stricture were analyzed.
      Results  The examination results of color Doppler ultrasound, magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in 4 patients suggested biliary anastomotic stricture with intrahepatic biliary dilatation, and 2 of them were complicated with intrahepatic biliary calculi. Repeated placement of biliary stent under ERCP yielded poor effect in 3 cases. SpyGlass direct visualization system examination hinted biliary anastomotic stricture in 4 patients, 3 cases of intrahepatic biliary dilatation, 3 cases of intrahepatic biliary calculi, 2 cases of purulent bile and 3 cases of floccules within the biliary tract, 1 case of congestion and edema of biliary tract wall and 2 cases of local epithelial necrosis and stiffness changes of intrahepatic biliary tract wall. The wire could not be inserted in 1 patient due to severe biliary anastomotic stricture. Four patients were treated with biliary stricture resection + biliary stone removal + biliary end-to-end anastomosis, biliary stricture resection + biliary-intestinal anastomosis, ERCP lithotomy + biliary metal stent implantation, and biliary metal stent implantation + percutaneous transhepatic bile duct lithotomy, respectively. Relevant symptoms were relieved without evident complications. All patients survived during the follow-up until the submission date.
      Conclusions  Compared with traditional imaging examination, SpyGlass direct visualization system may more directly display the morphological characteristics of biliary tract wall and structural changes within biliary tract cavity, which is an effective examination tool for biliary stricture after liver transplantation. In addition, individualized treatment methods may be adopted for different biliary tract diseases, which is expected to improve clinical prognosis of patients.

     

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