中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (53): 10039-10042.doi: 10.3969/j.issn.1673-8225.2010.53.038

• 器官移植临床实践 clinical practice of organ transplantation • 上一篇    下一篇

经T型管及其窦道治疗原位肝移植后胆道狭窄　

李虎城1，敖国昆1，杜国盛1，邹一平1，刘吉奎2，陈  飞2，王小军2   

  1. 1解放军三〇九医院全军器官移植中心肝胆外科，北京市   100091；2解放军第三军医大学全军肝胆外科研究所，重庆市    400038
  • 出版日期:2010-12-31 发布日期:2010-12-31
  • 作者简介:李虎城 buzzbuzz@126.com

Treatment for biliary tract stricture through T tube or its fibrous tract following orthotopic liver transplantation

Li Hu-cheng1, Ao Guo-kun1, Du Guo-sheng1, Zou Yi-ping1, Liu Ji-kui2, Chen Fei2, Wang Xiao-jun2   

  1. 1 Department of Hepatobiliary Surgery, Organ Transplantation Center, the 309 Hospital of Chinese PLA, Beijing  100091, China; 2 Institute of Hepatobiliary Surgery, Third Military Medical University of Chinese PLA, Chongqing  400038, China
  • Online:2010-12-31 Published:2010-12-31
  • About author:Li Hu-cheng, Department of Hepatobiliary Surgery, Organ Transplantation Center, the 309 Hospital of Chinese PLA, Beijing 100091, China buzzbuzz@126.com

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摘要：

背景：胆道并发症是原位肝移植后常见的并发症，也是目前导致肝移植失败的主要原因之一。
目的：评价经T型管及其窦道治疗原位肝移植后胆道狭窄的可行性。
方法：纳入原位肝移植后出现胆道狭窄的16例患者，共行胆道造影和气囊扩张成形术46次，其中1例行胆道支架置入。单例最多行胆道造影和气囊扩张成形术11次。对患者进行随访观察。
结果与结论：2例胆道狭窄合并胆瘘患者和1例单纯吻合口狭窄患者，经气囊扩张和胆道引流后痊愈。5例肝内外胆管多发狭窄患者，气囊反复扩张胆道狭窄段后，4例狭窄纠正而获得痊愈；1例气囊扩张治疗后出现肝内血肿，再次行肝移植。8例肝内外胆管多发狭窄合并胆泥的患者，经反复球气扩张后，6例狭窄明显减轻，黄疸缓解；1例置入胆道支架，后因支架管阻塞而再次肝移植；1例治疗后狭窄仍存在，黄疸无缓解而再次肝移植。提示经T型管及其窦道治疗原位肝移植后胆道狭窄具有操作简单、成功率高、痛苦小、创伤轻以及可重复等优点，是治疗原位肝移植后胆道狭窄的有效方法。但部分患者狭窄及梗阻难以纠正，需要再次肝脏移植。

关键词: 胆道并发症, 原位肝移植, T型管, 窦道, 支架置入

Abstract:

BACKGROUND: Biliary complication commonly occurred after orthotopic liver transplantation, which is one of the main reasons for failure of transplantation.
OBJECTIVE: To discuss feasibility of interventional management through T tube or its fibrous tract for treating biliary tract complications after orthotopic liver transplantation.
METHODS: Totally 16 patients suffering biliary tract complications after orthotopic liver transplantation and in totally received 46 times of cholangiography and balloon dilation were included, one of which underwent biliary stent implantation. One patient underwent 11 times of cholangiography and balloon dilation. All patients were followed-up.
RESULTS AND CONCLUSION: After biliary balloon dilation, 2 cases of stricture with leaks, 1 cases of biliary anastomotic stricture and 4 cases of multiple strictures were recovered. One multiple stricture patient had a hepatic hematoma after biliary balloon dilation and received a second transplantation. Six cases of multiple strictures with biliary sludge were catabatic. One case of multiple strictures with biliary sludge received the stent treatment, but much sludge blocked the tract and stent. Only one case was not catabatic and received a second transplantation. The interventional management through T tube or its fibrous tract for biliary tract stricture after orthotopic liver transplantation is efficient, convenient, and minimally invasive. It may be an effective way for these complications. However, a second liver transplantation should be performed for parts of patients who had uncontrollable stenosis.

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