原位肝移植术后胆道充盈缺损性胆系并发症探究.docVIP

原位肝移植术后胆道充盈缺损性胆系并发症探究 　 作者：何宇 张雷达 卢倩 丁钧 杨占宇 李智华 别平 王曙光 董家鸿　 ‘ 【摘要】 目的 探讨原位肝移植术后胆道充盈缺损性胆系并发症的病因及处理。方法 回顾性分析1999年2月至2005年12月完成的325例原位肝移植的临床资料。结果 术后发生胆泥3例，胆总管结石10例，胆管铸型综合征6例。MRCP或ERCP诊断准确率为100%，B超诊断准确率为78.9%。11例通过内镜介入取出结石、胆泥或铸型物，手术取石4例，再次肝移植手术4例。结论 肝移植术后发生胆道充盈缺损性胆系并发症可能与缺血灌注损伤、胆道缺血、排斥反应和CMV感染等因素有关。胆道成像技术有助于诊断及鉴别诊断。内镜治疗是首选方法，手术应在介入治疗无效后考虑。 【关键词】 肝移植； 胆道并发症； 充盈缺损征； 胆管结石； 胆泥； 胆管铸型综合征 Pathogenesis study of biliary filling defect related complications following orthotopic liver transplantation 【Abstract】 Objective To discuss pathogenesis and management of biliary filling defect related complications following orthotopic liver transplantation (OLT). Methods Clinical date of 325 cases treated with OLT from February 1999 to December 2005 in our department were retrospectively analysed. Results There were 3 cases with sludge, 10 with biliary stone and 6 with biliary cast syndrome, with accuracy rate of diagnosis of MRCP/ERCP for 100% and that of ultrasound for 76.9%. Stone, sludge or cast in 11 cases were removed from bile duct by ERCP. The stone in 4 cases were removed by operation; while 4 cases received retransplantation of the liver. Conclusions The formation of biliary stone, sludge and biliary cast syndrome after OLT is mainly due to ischemic reperfusion injury, bile duct ischemia, postoperative rejection and CMV infection. Cholangiography technique is helpful for diagnosis and differential diagnosis of these biliary complications after OLT. With regard to treatment, endoscopic intervention is the first alternative and operation follows unsuccessful intervention. 【Key words】 Liver transplantation; Biliary complications; Filling defect; Biliary stone; Sludge; Biliary cast syndrome 肝移植是治疗终末期肝病的有效手段；而术后的胆道并发症已成为影响患者长期生存及移植肝功能的重要因素，其发生率在10%～34%［1］。胆泥、胆管结石及胆管铸形综合征的胆道成像特征性表现出充盈缺损征象。笔者将其归纳为“胆道充盈缺损性并发症”。为探讨胆系并发症的病因及处理方法，回顾性分析我院1999年2月至2005年12月325例次原位肝移植术的病例资料，现报道如下。 1 资料和方法 1.1 一般资料 325例次肝移植受者中男273例(其中4例行2次肝移植)，女48例；平均年龄46.7岁(17～70岁)。原发性肝癌134例，乙型肝炎后肝硬化97例，急性或慢性重型乙型病毒性肝炎7