• 四川大學(xué)華西醫(yī)院消化內(nèi)鏡中心(成都 610041);

　目的　 探討內(nèi)鏡治療在肝移植術(shù)后膽道并發(fā)癥中的作用。
　方法 　對(duì)我院2006年1月至2009年6月期間經(jīng)內(nèi)鏡診治的55例肝移植術(shù)后膽道并發(fā)癥患者的臨床資料進(jìn)行回顧性分析。
　結(jié)果 　55例肝移植術(shù)后出現(xiàn)膽道并發(fā)癥的患者共行內(nèi)鏡治療98例次，治療成功46例(83.6%)，其中單純膽瘺11例，膽管狹窄合并膽瘺4例，單純膽管狹窄21例，膽管狹窄伴結(jié)石12例，單純膽管結(jié)石3例，膽管扭曲2例，十二指腸乳頭狹窄2例。針對(duì)不同的膽道并發(fā)癥，采取了膽管擴(kuò)張、鼻膽管引流、乳頭切開(kāi)取石、膽道支架置放等不同的治療方式，發(fā)生內(nèi)鏡相關(guān)并發(fā)癥13例次(13.3%)。
　結(jié)論 　內(nèi)鏡處理肝移植術(shù)后膽道并發(fā)癥是一種安全、有效的方法,應(yīng)該作為首選方法在臨床上推廣應(yīng)用。

引用本文： 廖娟,李榮坤,王春暉,胡兵,唐承薇. 肝移植術(shù)后膽道并發(fā)癥的內(nèi)鏡治療. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(4): 333-337. doi: 復(fù)制

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1. Thethy S, Thomson BNj, Pleass H, et al. Management of biliary tract complications after orthotopic liver transplantation [J]. Clin Transplant, 2004; 18(6): 647-653.
2. 　Moser MA, Wall WJ. Management of biliary problems after liver transplantation [J]. Liver Transpl, 2001; 7(11 Suppl 1): S46-S52.
3. 　Patkowski W, Nyckowski P, Zieniewicz K, et al. Biliary tract complications following liver transplantation [J]. Transplant Proc, 2003; 35(6): 2316-2317.
4. 　Yuan D, Wei YG, Lin HM, et al. Risk factors of biliary complications following liver transplantation: retrospective analysis of a single centre [J]. Postgrad Med J, 2009; 85(1001): 119-123.
5. 　汪根樹(shù), 陳規(guī)劃, 陸敏強(qiáng), 等. 原位肝移植術(shù)后膽管狹窄的治療(附43例報(bào)告) [J]. 中國(guó)實(shí)用外科雜志, 2006; 26(6): 432-433.
6. 　Egawa H, Inomata Y, Uemoto S, et al. Biliary anastomotic complications in 400 living related liver transplantations [J]. World J Surg, 2001; 25(10): 1300-1307.
7. 　Halme L, Hockerstedt K, Lautenschlager I. Cytomegalovirus infection and development of biliary complications after liver transplantation [J]. Transplantation, 2003; 75(11): 1853-1858.
8. 　Shah SR, Dooley J, Agarwal R, et al. Routine endoscopic retrograde cholangiography in the detection of early biliary complications after liver transplantation [J]. Liver Transpl, 2002; 8(5): 491-494.
9. 　Park JS, Kim MH, Lee SK, et al. Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation [J]. Gastrointest Endosc, 2003; 57(1): 78-85.
10. 　Cescon M, Grazi GL, Ravaioli M, et al. Conventional split liver transplantation for two adult recipients: a recent experience in a single European center [J]. Transplantation, 2009; 88(9): 1117-1122.
11. 　冉江華, 張升寧, 李鑄, 等. 肝動(dòng)脈-腹主動(dòng)脈搭橋在原位肝移植術(shù)中的應(yīng)用 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(2): 102-105.
12. 　陳剛, 朱鋒, 劉其雨, 等. 存在大血管侵犯的肝癌患者的肝移植(附8例報(bào)道) [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(7): 484-486.
13. 　Wojcicki M, Lubikowski J, Klek R, et al. Reduction of biliary complication rate using continuous suture and no biliary drainage for duct-to-duct anastomosis in whole-organ liver transplantation [J]. Transplant Proc, 2009; 41(8): 3126-3130.
14. 　Saidi RF, Elias N, Ko DS, et al. Biliary reconstruction and complications after living-donor liver transplantation [J]. HPB (Oxford), 2009; 11(6): 505-509.
15. 　朱新鋒, 陳剛, 張文奪, 等. 肝移植術(shù)后應(yīng)用胸腺肽α1對(duì)急性排斥反應(yīng)的影響 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(6): 430-434.
16. 　Kyoden Y, Tamura S, Sugawara Y, et al. Incidence and management of biliary complications after adult-to-adult living donor liver transplantation [J]. Clin Transplant, 2009 Oct 22 [Epub ahead of print].
17. 　Rerknimitr R, Sherman S, Fogel EL, et al. Biliary tract complications after orthotopic liver transplantation with choledochocholedochostomy anastomosis: endoscopic findings and results of therapy [J]. Gastrointest Endosc, 2002; 55(2): 224-231.
18. 　Solmi L, Cariani G, Leo P, et al. Results of endoscopic retrograde cholangiopancreatography in the treatment of biliary tract complications after orthotopic liver transplantation: our experience [J]. Hepatogastroenterology, 2007; 54(76): 1004-1008.
19. 　Icoz G, Kilic M, Zeytunlu M, et al. Biliary reconstructions and complications encountered in 50 consecutive right-lobe living donor liver transplantations [J]. Liver Transpl, 2003; 9(6): 575-580.
20. 　Pasha SF, Harrison ME, Das A, et al. Endoscopic treatment of anastomotic biliary strictures after deceased donor liver transplantation: outcomes after maximal stent therapy [J]. Gastrointest Endosc, 2007; 66(1): 44-51.
21. 　Elmi F, Silverman WB. Outcome of ERCP in the management of duct-to-duct anastomotic strictures in orthotopic liver transplant [J]. Dig Dis Sci, 2007; 52(9): 2346-2350.
22. 　Mahajani RV, Cotler SJ, Uzer MF. Efficacy of endoscopic management of anastomotic biliary strictures after hepatic transplantation [J]. Endoscopy, 2000; 32(12): 943-949.
23. 　Thuluvath PJ, Atassi T, Lee J. An endoscopic approach to biliary complications following orthotopic liver transplantation [J]. Liver Int, 2003; 23(3): 156-162.
24. 　Scanga AE, Kowdley KV. Management of biliary complications following orthotopic liver transplantation [J]. Curr Gastroenterol Rep, 2007; 9(1): 31-38.
25. 　Spier BJ, Pfau PR, Lorenze KR, et al. Risk factors and outcomes in post-liver transplantation bile duct stones and casts: A case-control study [J]. Liver Transpl, 2008; 14(10): 1461-1465.
  1. 1. Thethy S, Thomson BNj, Pleass H, et al. Management of biliary tract complications after orthotopic liver transplantation [J]. Clin Transplant, 2004; 18(6): 647-653.
  2. 2. 　Moser MA, Wall WJ. Management of biliary problems after liver transplantation [J]. Liver Transpl, 2001; 7(11 Suppl 1): S46-S52.
  3. 3. 　Patkowski W, Nyckowski P, Zieniewicz K, et al. Biliary tract complications following liver transplantation [J]. Transplant Proc, 2003; 35(6): 2316-2317.
  4. 4. 　Yuan D, Wei YG, Lin HM, et al. Risk factors of biliary complications following liver transplantation: retrospective analysis of a single centre [J]. Postgrad Med J, 2009; 85(1001): 119-123.
  5. 5. 　汪根樹(shù), 陳規(guī)劃, 陸敏強(qiáng), 等. 原位肝移植術(shù)后膽管狹窄的治療(附43例報(bào)告) [J]. 中國(guó)實(shí)用外科雜志, 2006; 26(6): 432-433.
  6. 6. 　Egawa H, Inomata Y, Uemoto S, et al. Biliary anastomotic complications in 400 living related liver transplantations [J]. World J Surg, 2001; 25(10): 1300-1307.
  7. 7. 　Halme L, Hockerstedt K, Lautenschlager I. Cytomegalovirus infection and development of biliary complications after liver transplantation [J]. Transplantation, 2003; 75(11): 1853-1858.
  8. 8. 　Shah SR, Dooley J, Agarwal R, et al. Routine endoscopic retrograde cholangiography in the detection of early biliary complications after liver transplantation [J]. Liver Transpl, 2002; 8(5): 491-494.
  9. 9. 　Park JS, Kim MH, Lee SK, et al. Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation [J]. Gastrointest Endosc, 2003; 57(1): 78-85.
  10. 10. 　Cescon M, Grazi GL, Ravaioli M, et al. Conventional split liver transplantation for two adult recipients: a recent experience in a single European center [J]. Transplantation, 2009; 88(9): 1117-1122.
  11. 11. 　冉江華, 張升寧, 李鑄, 等. 肝動(dòng)脈-腹主動(dòng)脈搭橋在原位肝移植術(shù)中的應(yīng)用 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(2): 102-105.
  12. 12. 　陳剛, 朱鋒, 劉其雨, 等. 存在大血管侵犯的肝癌患者的肝移植(附8例報(bào)道) [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(7): 484-486.
  13. 13. 　Wojcicki M, Lubikowski J, Klek R, et al. Reduction of biliary complication rate using continuous suture and no biliary drainage for duct-to-duct anastomosis in whole-organ liver transplantation [J]. Transplant Proc, 2009; 41(8): 3126-3130.
  14. 14. 　Saidi RF, Elias N, Ko DS, et al. Biliary reconstruction and complications after living-donor liver transplantation [J]. HPB (Oxford), 2009; 11(6): 505-509.
  15. 15. 　朱新鋒, 陳剛, 張文奪, 等. 肝移植術(shù)后應(yīng)用胸腺肽α1對(duì)急性排斥反應(yīng)的影響 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(6): 430-434.
  16. 16. 　Kyoden Y, Tamura S, Sugawara Y, et al. Incidence and management of biliary complications after adult-to-adult living donor liver transplantation [J]. Clin Transplant, 2009 Oct 22 [Epub ahead of print].
  17. 17. 　Rerknimitr R, Sherman S, Fogel EL, et al. Biliary tract complications after orthotopic liver transplantation with choledochocholedochostomy anastomosis: endoscopic findings and results of therapy [J]. Gastrointest Endosc, 2002; 55(2): 224-231.
  18. 18. 　Solmi L, Cariani G, Leo P, et al. Results of endoscopic retrograde cholangiopancreatography in the treatment of biliary tract complications after orthotopic liver transplantation: our experience [J]. Hepatogastroenterology, 2007; 54(76): 1004-1008.
  19. 19. 　Icoz G, Kilic M, Zeytunlu M, et al. Biliary reconstructions and complications encountered in 50 consecutive right-lobe living donor liver transplantations [J]. Liver Transpl, 2003; 9(6): 575-580.
  20. 20. 　Pasha SF, Harrison ME, Das A, et al. Endoscopic treatment of anastomotic biliary strictures after deceased donor liver transplantation: outcomes after maximal stent therapy [J]. Gastrointest Endosc, 2007; 66(1): 44-51.
  21. 21. 　Elmi F, Silverman WB. Outcome of ERCP in the management of duct-to-duct anastomotic strictures in orthotopic liver transplant [J]. Dig Dis Sci, 2007; 52(9): 2346-2350.
  22. 22. 　Mahajani RV, Cotler SJ, Uzer MF. Efficacy of endoscopic management of anastomotic biliary strictures after hepatic transplantation [J]. Endoscopy, 2000; 32(12): 943-949.
  23. 23. 　Thuluvath PJ, Atassi T, Lee J. An endoscopic approach to biliary complications following orthotopic liver transplantation [J]. Liver Int, 2003; 23(3): 156-162.
  24. 24. 　Scanga AE, Kowdley KV. Management of biliary complications following orthotopic liver transplantation [J]. Curr Gastroenterol Rep, 2007; 9(1): 31-38.
  25. 25. 　Spier BJ, Pfau PR, Lorenze KR, et al. Risk factors and outcomes in post-liver transplantation bile duct stones and casts: A case-control study [J]. Liver Transpl, 2008; 14(10): 1461-1465.