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SpyGlass内镜直视系统在原位肝移植术后复杂胆道并发症中的应用

王旋, 李甫, 唐睿, 等. SpyGlass内镜直视系统在原位肝移植术后复杂胆道并发症中的应用[J]. 器官移植, 2023, 14(3): 404-410. doi: 10.3969/j.issn.1674-7445.2023.03.012
引用本文: 王旋, 李甫, 唐睿, 等. SpyGlass内镜直视系统在原位肝移植术后复杂胆道并发症中的应用[J]. 器官移植, 2023, 14(3): 404-410. doi: 10.3969/j.issn.1674-7445.2023.03.012
Wang Xuan, Li Fu, Tang Rui, et al. Application of SpyGlass endoscopic direct visualization system in complicated biliary complications after orthotopic liver transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(3): 404-410. doi: 10.3969/j.issn.1674-7445.2023.03.012
Citation: Wang Xuan, Li Fu, Tang Rui, et al. Application of SpyGlass endoscopic direct visualization system in complicated biliary complications after orthotopic liver transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(3): 404-410. doi: 10.3969/j.issn.1674-7445.2023.03.012

SpyGlass内镜直视系统在原位肝移植术后复杂胆道并发症中的应用

doi: 10.3969/j.issn.1674-7445.2023.03.012
基金项目: 

国家自然科学基金 81904017

详细信息
    作者简介:
    通讯作者:

    张晞文(ORCID:0009-0001-7236-3922),博士,主任医师,研究方向为ERCP在肝胆胰疾病中的应用,Email:yclifu17@163.com

  • 中图分类号: R617, R575

Application of SpyGlass endoscopic direct visualization system in complicated biliary complications after orthotopic liver transplantation

More Information
  • 摘要:   目的  探讨SpyGlass内镜直视系统在原位肝移植术后复杂胆道并发症中的应用效果。  方法  回顾性分析369例因成人原位肝移植术后胆道并发症首次行内镜逆行胰胆管造影术(ERCP)治疗患者的临床资料。分析接受SpyGlass治疗患者的术前情况、术中表现、治疗转归及并发症。  结果  56例患者接受SpyGlass治疗,主要术前体征包括腹部不适38例、发热8例、黄疸6例、皮肤瘙痒4例。18例患者行超声检查,提示胆总管狭窄,肝内胆管明显扩张。56例患者术前均行磁共振胰胆管成像(MRCP)检查,其中胆总管狭窄合并结石36例、单纯胆总管狭窄16例、考虑肿瘤可能4例,均具有明确的SpyGlass治疗指征。56例接受SpyGlass治疗患者中,吻合口狭窄合并结石34例、单纯吻合口狭窄12例、单纯胆道结石1例、肿瘤4例。48例SpyGlass操作成功者术后48 h丙氨酸转氨酶、天冬氨酸转氨酶、γ-谷氨酰转移酶、碱性磷酸酶、总胆红素水平均较术前下降(均为P<0.05)。56例经SpyGlass治疗患者未出现严重并发症。  结论  SpyGlass在肝移植术后复杂胆道并发症治疗中能够明显提高治疗成功率,安全性较高,值得推广应用。

     

  • 图  1  肝移植术后胆道并发症影像学检查

    注:A图为肝移植术后吻合口狭窄超声影像;B图为吻合口狭窄胆管近端结石MRCP影像;C图为吻合口狭窄胆管远端结石MRCP影像;D图为肝移植术后单纯吻合口狭窄MRCP影像。

    Figure  1.  Imaging examination of biliary complications after liver transplantation

    图  2  SpyGlass直视下胆管内部图像

    注:A图为吻合口狭窄合并胆管结石;B图为吻合口狭窄合并胆栓形成;C图为瘢痕愈合导致的吻合口狭窄;D图为缝合导致的吻合口狭窄;E图为单纯胆总管结石;F图为肿瘤再发导致的胆管梗阻。

    Figure  2.  Images of the inside of the bile duct under direct vision with SpyGlass

    图  3  患者胆管逆行造影图

    注:A图为吻合口狭窄(箭头所示);B图为胆管球囊扩张成型术(箭头所示);C图为胆管支架联合鼻胆管引流;D图为经皮经肝胆道引流术(箭头所示)。

    Figure  3.  Retrograde cholangiography of the patients

    表  1  48例成功行SpyGlass治疗患者前后肝功能指标比较

    Table  1.   Comparison of liver function indexes before and after successful SpyGlass treatment in 48 patients [M (P25, P75)]

    指标 n 治疗前 治疗后 Z P
    丙氨酸转氨酶(U/L) 48 122(79, 199) 33(23, 54) 8.434 <0.001
    天冬氨酸转氨酶(U/L) 48 124(103, 168) 38(26, 68) 9.971 <0.001
    γ-谷氨酰转移酶(U/L) 48 248(168, 353) 64(53, 80) 8.538 <0.001
    碱性磷酸酶(U/L) 48 305(214, 450) 152(124, 174) 8.757 <0.001
    总胆红素(μmol/L) 48 83(32, 111) 25(19, 33) 7.379 <0.001
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  • 收稿日期:  2022-12-17
  • 刊出日期:  2023-05-15

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