Etiology and Endoscopic Treatment of Biliary Complications after Liver Transplantation(Report of 32 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 范林 ¹ , 涂強 ¹ , 喬兵兵 ¹ , 熊艷 ¹ , 李弦 ¹ ,  葉啟發 ^1,2

1. ;
2. ;

Corresponding?author：

葉啟發, Email: yqf_china@163.com

Keywords：

肝移植; 膽道并發癥; 病因; 內鏡治療

DOI：

10.7507/1007-9424.20140016

Video：

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目的探討肝移植術后膽道并發癥的病因及內鏡在肝移植并發癥中的治療。方法筆者所在單位1995年9月至2010年3月期間共施行尸體肝移植516例，將其分為2個階段，即1995～2001年的技術摸索階段和2001～2010年的技術成熟階段。第1階段125例，有17例（13.60%）發生膽道并發癥；第2階段391例，有15例（3.84%）發生膽道并發癥。對這32例患者行內鏡診治的相關臨床資料進行回顧性分析。結果 32例中單純膽瘺5例，單純膽管結石2例，單純膽管狹窄11例，膽管狹窄伴結石9例，膽管狹窄合并膽瘺2例，膽管扭曲2例，十二指腸乳頭狹窄1例。針對不同的膽道并發癥，采取了膽管擴張、乳頭切開取石、膽道支架置放、鼻膽管引流等不同的治療方式，32例患者共行內鏡治療56例次，治療成功27例（84.38%）；發生內鏡相關并發癥4例（12.50%）。結論內鏡治療肝移植術后膽道并發癥的療效是值得肯定的。

Citation： 范林, 涂強, 喬兵兵, 熊艷, 李弦, 葉啟發. Etiology and Endoscopic Treatment of Biliary Complications after Liver Transplantation(Report of 32 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(1): 82-84. doi: 10.7507/1007-9424.20140016 Copy

1.	何炳均, 劉靜靜, 王勁, 等.肝移植術后膽道并發癥的MRCP表現[J].中山大學學報:醫學科學版, 2012, 33(1):132-133.
2.	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.
3.	Hampe T, Dogan A, Encke J, et al.Biliary complications after liver transplantation[J].Clin Transplant, 2006, 20 Suppl 17:93-96.
4.	Kochhar G, Parungao JM, Hanouneh IA, et al.Biliary complications following liver transplantation[J].World J Gastroenterol, 2013, 19(19):2841-2846.
5.	黃文峰, 張小玲, 謝志軍, 等.肝移植的研究進展及常見并發癥處理[J].中國組織工程研究, 2012, 16(5):176-177.
6.	汪根樹, 陳規劃, 陸敏強, 等.原位肝移植術后膽管狹窄的治療(附43例報告)[J].中國實用外科雜志, 2006, 26(6):432-434.
7.	唐曉旭.肝移植術后膽管并發癥的病因及治療研究進展[J].人民軍醫, 2012, 55(4):209-210.
8.	董長城.肝移植術后膽道并發癥的預防及治療[J].亞太傳統醫藥, 2010, 6(2):67-68.
9.	Guichelaar MM, Benson JT, Malinchoc M, et al.Risk factors for and clinical course of non-anastomotic biliary strictures after liver transplantation[J].Am J Transplant, 2003, 3(7):885-890.
10.	Warner PR, Nester TA.ABO-incompatible solid-organ transplantation[J].Am J Clin Pathol, 2006, 125 Suppl:S87-S94.
11.	Harvala H, Stewart C, Muller K, et al.High risk of cytomegalovirus infection following solid organ transplantation despite prophylactic therapy[J].J Med Virol, 2013, 85(5):893-898.
12.	Verdonk RC, Buis CI, Pone RJ, et al.Biliary complications after liver transplantation:a review[J].Scand J Gastroenterol Suppl, 2006, (243):89-101.
13.	Beltran MM, Marugan RB, Oton E, et al.Accuracy of magneticresonance cholangiography in the evaluation of late biliary complications after orthotopic liver transplantation[J].Transplantation Proceedings, 2005, 37(9):3924-3925.
14.	Buis CI, Geuken E, Visser DS, et al.Ischemic-type biliary lesi-ons after human liver transplantation are preceded by abnormal bile composition[J].Eur J Gastroenterol Hepatol, 2006, 18(1):A51-A52.
15.	Kusano T, Randall HB, Roberts JP, et al.The use of stents for duct-to-duct anastomoses of biliary reconstruction in orthotopic liver transplantation[J].Hepatogastroenterology, 2005, 52(63):695-699.
16.	Ribeiro JB, Martins Fde S, Garcia JH, et al.Endoscopic management of biliary complications after liver transplantation[J].Arq Bras Cir Dig, 2012, 25(4):269-272.
17.	Luigiano C, Bassi M, Ferrara F, et al.Placement of a new fully covered self-expanding metal stent for postoperative biliary strictures and leaks not responding to plastic stenting[J].Surg Laparosc Endosc Percutan Tech, 2013, 23(2):159-162.
18.	Kurita A, Kodama Y, Minami R, et al.Endoscopic stent placement above the intact sphincter of Oddi for biliary strictures after living donor liver transplantation[J].J Gastroenterol, 2013, 48(9):1097-1104.

1. 何炳均, 劉靜靜, 王勁, 等.肝移植術后膽道并發癥的MRCP表現[J].中山大學學報:醫學科學版, 2012, 33(1):132-133.
2. 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.
3. Hampe T, Dogan A, Encke J, et al.Biliary complications after liver transplantation[J].Clin Transplant, 2006, 20 Suppl 17:93-96.
4. Kochhar G, Parungao JM, Hanouneh IA, et al.Biliary complications following liver transplantation[J].World J Gastroenterol, 2013, 19(19):2841-2846.
5. 黃文峰, 張小玲, 謝志軍, 等.肝移植的研究進展及常見并發癥處理[J].中國組織工程研究, 2012, 16(5):176-177.
6. 汪根樹, 陳規劃, 陸敏強, 等.原位肝移植術后膽管狹窄的治療(附43例報告)[J].中國實用外科雜志, 2006, 26(6):432-434.
7. 唐曉旭.肝移植術后膽管并發癥的病因及治療研究進展[J].人民軍醫, 2012, 55(4):209-210.
8. 董長城.肝移植術后膽道并發癥的預防及治療[J].亞太傳統醫藥, 2010, 6(2):67-68.
9. Guichelaar MM, Benson JT, Malinchoc M, et al.Risk factors for and clinical course of non-anastomotic biliary strictures after liver transplantation[J].Am J Transplant, 2003, 3(7):885-890.
10. Warner PR, Nester TA.ABO-incompatible solid-organ transplantation[J].Am J Clin Pathol, 2006, 125 Suppl:S87-S94.
11. Harvala H, Stewart C, Muller K, et al.High risk of cytomegalovirus infection following solid organ transplantation despite prophylactic therapy[J].J Med Virol, 2013, 85(5):893-898.
12. Verdonk RC, Buis CI, Pone RJ, et al.Biliary complications after liver transplantation:a review[J].Scand J Gastroenterol Suppl, 2006, (243):89-101.
13. Beltran MM, Marugan RB, Oton E, et al.Accuracy of magneticresonance cholangiography in the evaluation of late biliary complications after orthotopic liver transplantation[J].Transplantation Proceedings, 2005, 37(9):3924-3925.
14. Buis CI, Geuken E, Visser DS, et al.Ischemic-type biliary lesi-ons after human liver transplantation are preceded by abnormal bile composition[J].Eur J Gastroenterol Hepatol, 2006, 18(1):A51-A52.
15. Kusano T, Randall HB, Roberts JP, et al.The use of stents for duct-to-duct anastomoses of biliary reconstruction in orthotopic liver transplantation[J].Hepatogastroenterology, 2005, 52(63):695-699.
16. Ribeiro JB, Martins Fde S, Garcia JH, et al.Endoscopic management of biliary complications after liver transplantation[J].Arq Bras Cir Dig, 2012, 25(4):269-272.
17. Luigiano C, Bassi M, Ferrara F, et al.Placement of a new fully covered self-expanding metal stent for postoperative biliary strictures and leaks not responding to plastic stenting[J].Surg Laparosc Endosc Percutan Tech, 2013, 23(2):159-162.
18. Kurita A, Kodama Y, Minami R, et al.Endoscopic stent placement above the intact sphincter of Oddi for biliary strictures after living donor liver transplantation[J].J Gastroenterol, 2013, 48(9):1097-1104.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Etiology and Endoscopic Treatment of Biliary Complications after Liver Transplantation(Report of 32 Cases)

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