Righi Dorico, Cesarani Federico, Muraro Emanuele, Gazzera Carlo, Salizzoni Mauro, Gandini Giovanni
Istituto di Radiologia Diagnostica ed Interventistica, Universita di Torino, Ospedale Molinette, via Genova 3, I-10126 Turin, Italy.
Cardiovasc Intervent Radiol. 2002 Jan-Feb;25(1):30-5. doi: 10.1007/s00270-001-0078-7. Epub 2002 Jan 17.
To evaluate the efficacy and safety of percutaneous treatment of biliary strictures complicating orthotopic liver transplantation (OLT).
Between October 1990 and May 2000, 619 patients underwent 678 liver transplants. Seventy of the 619 (11%) patients were found to be affected by biliary strictures by July 2000. Bilioplasty was performed in 51 of these 70 (73%) patients. A cohort of 33 of 51 (65%) patients were clinically followed for more than 12 months after the last percutaneous treatment and included in the survey results.
After one to three treatments 24 of 33 (73%) patients were stricture-free on ultrasound and MR cholangiography follow-up. A delayed stricture recurrence required a fourth percutaneous bilioplasty in two of 33 (6%) patients. A surgical bilioenteric anastomosis was performed in six of 33 (18%) patients. Retransplantation was performed due to ischemic damage in one of 33 (3%) patients.
Interventional radiology is an effective therapeutic alternative for the treatment of most biliary strictures complicating OLT. It has a high success rate and should be considered before surgical interventions. Elective surgery may be necessary in a few failed cases or those with more severe and extensive biliary strictures.
评估经皮治疗原位肝移植（OLT）术后并发的胆管狭窄的疗效和安全性。
1990年10月至2000年5月期间，619例患者接受了678次肝移植。截至2000年7月，619例患者中有70例（11%）被发现患有胆管狭窄。这70例患者中的51例（73%）接受了胆管成形术。51例患者中的33例（65%）在最后一次经皮治疗后进行了超过12个月的临床随访，并纳入调查结果。
经过一至三次治疗后，33例患者中的24例（73%）在超声和磁共振胆管造影随访中无狭窄。33例患者中有2例（6%）出现延迟性狭窄复发，需要进行第四次经皮胆管成形术。33例患者中有6例（18%）进行了外科胆肠吻合术。33例患者中有1例（3%）因缺血性损伤进行了再次移植。
介入放射学是治疗OLT术后并发的大多数胆管狭窄的一种有效治疗选择。它具有较高的成功率，在手术干预前应予以考虑。少数治疗失败的病例或胆管狭窄更严重、范围更广的病例可能需要择期手术。
