Park Ju Sang, Kim Myung-Hwan, Lee Sung Koo, Seo Dong Wan, Lee Sang Soo, Han Jimin, Min Young Il, Hwang Shin, Park Kwang Min, Lee Young Joo, Lee Seung Gyu, Sung Kyu Bo
Department of Internal Medicine, General Surgery, and Interventional Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Gastrointest Endosc. 2003 Jan;57(1):78-85. doi: 10.1067/mge.2003.11.
Percutaneous transhepatic radiologic procedures as well as ERCP-based techniques have been used to treat biliary complications after liver transplantation. However, the efficacy of these treatments has not yet been clarified, especially for complications occurring after living donor liver transplantation.
A retrospective study was performed to determine the frequency and types of the biliary complications after cadaveric donor liver transplantation and living donor liver transplantation. The success of ERCP and percutaneous transhepatic radiologic procedures was also evaluated. The choice of treatment approach, ERCP or percutaneous transhepatic radiologic procedures, depended on the type of biliary reconstruction and accessibility of the lesion.
Among 429 adult patients who underwent liver transplantation, 39 biliary complications developed in 25 patients (5.8%): biliary stricture (20), biliary stones (10), and bile leak (9). The frequency of biliary complications (5.8%; 6/103) after cadaveric donor liver transplantation was not significantly different compared with that after living donor liver transplantation (5.8%; 19/326). Success rates for treatment of biliary complications by means of ERCP and percutaneous transhepatic radiologic procedures were, respectively, 100% (11/11) and 78% (18/23). For endoscopically treated patients, balloon dilation alone for biliary strictures and nasobiliary tube placement alone for bile leaks resulted in complete resolution of the complication in, respectively, 67% (2/3) and 40% (2/5) without further intervention.
Transpapillary endoscopic and percutaneous transhepatic radiologic interventions are both effective therapies for biliary complications associated with liver transplantation. They are complementary approaches that help to avoid surgery for these complications.
经皮肝穿刺放射学操作以及基于内镜逆行胰胆管造影（ERCP）的技术已被用于治疗肝移植术后的胆道并发症。然而，这些治疗方法的疗效尚未明确，尤其是对于活体供肝肝移植术后发生的并发症。
进行一项回顾性研究，以确定尸体供肝肝移植和活体供肝肝移植术后胆道并发症的发生率和类型。同时评估ERCP和经皮肝穿刺放射学操作的成功率。治疗方法的选择，即ERCP或经皮肝穿刺放射学操作，取决于胆道重建的类型和病变的可及性。
在429例接受肝移植的成年患者中，25例患者（5.8%）出现了39例胆道并发症：胆管狭窄（20例）、胆石症（10例）和胆漏（9例）。尸体供肝肝移植术后胆道并发症的发生率（5.8%；6/103）与活体供肝肝移植术后（5.8%；19/326）相比无显著差异。通过ERCP和经皮肝穿刺放射学操作治疗胆道并发症的成功率分别为100%（11/11）和78%（18/23）。对于接受内镜治疗的患者，单纯球囊扩张治疗胆管狭窄和单纯鼻胆管置入治疗胆漏分别使67%（2/3）和40%（2/5）的并发症完全缓解，无需进一步干预。
经乳头内镜和经皮肝穿刺放射学干预都是治疗肝移植相关胆道并发症的有效方法。它们是互补的方法，有助于避免针对这些并发症进行手术。
