肝移植术后胆道狭窄经皮肝穿刺胆管造影的并发症及其预防

摘要

目的 观察经皮肝穿刺胆道介入治疗原位肝移植术后胆道狭窄发生并发症的频次和类型.资料与方法 对292例原位肝移植术后出现胆道狭窄的30例患者分别行胆道球囊扩张术、胆道引流术和胆道支架置入术,观察术中反应、术后临床经过、相关实验室检查、B超和复查胆道造影表现.结果 3例(10.0％)胆道狭窄合并胆瘘患者和3例(10.0％)单纯吻合口狭窄患者行气囊扩张术和胆道引流后痊愈.8例(26.7％)肝内外胆管多发狭窄患者气囊反复扩张胆道狭窄段后,7例狭窄纠正而获得痊愈.14例(46.7％)肝内外胆管多发狭窄合并胆泥患者中12例(40.0％)狭窄明显减轻,黄疸缓解；2例(6.7％)T形管引流口段狭窄行经皮肝穿刺胆道引流术后,狭窄明显减轻,黄疸缓解.30例患者(100.0％)术中均感疼痛,其中12例(40.0％)疼痛剧烈.2例(6.7％)术中发生出血,其中1例再次行肝移植.27例(90.0％)术后胆管仍再狭窄,需反复多次成形.2例(6.7％)治疗后狭窄持续存在而再次行肝移植,其中1例曾置入胆道支架,另1例直接行二次肝移植.结论 疼痛、再狭窄是经皮肝穿刺胆道介入治疗肝移植术后胆道狭窄的常见并发症,术中预防大出血是降低风险的关键.%Purpose To investigate the frequency and patterns of complications after interventional management through percutaneous transhepatic puncture technique in biliary tract stricture after orthotopic liver transplantation. Materials and Methods A retrospective study of clinical and imaging data of 292 postoperative orthotopic liver transplantation cases was performed. In these 292 cases, 30 patients suffered from biliary tract complications and were treated with billiary balloon dilatation, bile drainage and biliary stenting. The complications were assessed based on reaction during the procedure, clinical observation, laboratory tests, ultrasonography and cholangiography. Results After biliary balloon dilatation, 3 cases (10.0%) with biliary tract strictures and leaks as well as 3 cases (10.0%) with simple biliary anastomosis strictures were cured. Seven out of 8 cases (26.7%) with multiple biliary tract strictures were cured. In 14 cases (46.7%) of multiple biliary tract strictures complicated by biliary sludge, 12 cases improved remarkably and the jaundice was corrected after repeated balloon dilatation. In 2 cases (6.7%) with strictures in the opening segment of the T tube, clinical improvement was achived after percutaneous transhepatic puncture. All 30 patients (100.0%) complained of pain during the procedure of which 12 (40.0%) were severe. Hemorrhage occurred in 2 patients (6.7%), one of which underwent the second liver transplantation. Biliary tract strictures recured in 27 patients after treatment requiring multiple cholangioplasties. The strictures were persistent in 2 cases (6.7%) and the patients were finally treated with retransplantation. Conclusion Pain and biliary restenosis were common complications after interventional management through percutaneous transhepatic puncture for biliary tract stricture after orthotopic liver transplantation. The key to reducing the risk is to prevent hemorrhea during the procedure.