Roumilhac Didier, Poyet Grégory, Sergent Géraldine, Declerck Nicole, Karoui Mehdi, Mathurin Phillippe, Ernst Olivier, Paris Jean-Claude, Gambiez Luc, Pruvot François-René
Service de Chirurgie Digestive et Transplantation, Hôpital Huriez, 59037 Lille Cedex, France.
Liver Transpl. 2003 Apr;9(4):394-400. doi: 10.1053/jlts.2003.50052.
The purpose of this study was to evaluate the results of percutaneous transhepatic management (PTM) of anastomotic biliary strictures (BS). Among 168 liver transplant adult recipients, BS was identified in 30 patients. In 6 patients, narrowing of the anastomosis was found early, and in all cases disappeared spontaneously with prolonged draining of the bile tube. Within a mean time of 14 months after transplantation, 24 patients had symptomatic BSs, revealed by cholestasis (n = 17) or cholangitis (n = 7). Twenty-two patients underwent PTM as first treatment of BS (balloon dilatation or stent placement). We evaluated the primary and secondary patency rate of PTM. In 1 patient, PTM failed because the stricture could not be passed with the guide wire, necessitating conversion to a Roux-en-Y choledochojejunostomy (CDJ). Fourteen patients were treated by percutaneous balloon dilatation from which 8 patients (57.2%) were recurrence-free with a mean follow-up of 61 months. One patient with a patent biliary anastomosis underwent retransplantation for acute rejection. Twelve patients received metallic expandable stent placement as their primary treatment (n = 7) or after failure of balloon dilatation (n = 5). Recurrent stricture was found in 7 cases (58%) and was treated by PTM (n = 6) or surgery (n = 1). The primary patency rate for PTM was 58.8% at 12 months and the secondary patency rate 88.4%, with a mean follow-up of 47 months (median: 44 months). The mortality rate was 3.5% (one death). PTM with balloon dilatation, stent placement, or both, represent a safe method to treat anastomotic BSs after orthotopic liver transplantation (OLT) resulting in a secondary patency rate of 88% at 5 years.
本研究的目的是评估经皮经肝处理吻合口胆管狭窄（BS）的结果。在168例成年肝移植受者中，30例患者发现有BS。6例患者早期发现吻合口狭窄，所有病例经胆管长期引流后狭窄均自行消失。移植后平均14个月时，24例患者出现有症状的BS，表现为胆汁淤积（n = 17）或胆管炎（n = 7）。22例患者接受PTM作为BS的首次治疗（球囊扩张或支架置入）。我们评估了PTM的一次通畅率和二次通畅率。1例患者PTM失败，因为导丝无法通过狭窄部位，需改行Roux-en-Y胆总管空肠吻合术（CDJ）。14例患者接受经皮球囊扩张治疗，其中8例（57.2%）在平均随访61个月时无复发。1例胆管吻合口通畅的患者因急性排斥反应接受再次移植。12例患者接受金属可扩张支架置入作为首次治疗（n = 7）或球囊扩张失败后治疗（n = 5）。7例（58%）发现复发性狭窄，分别接受PTM（n = 6）或手术（n = 1）治疗。PTM的一次通畅率在12个月时为58.8%，二次通畅率为88.4%，平均随访47个月（中位数：44个月）。死亡率为3.5%（1例死亡）。球囊扩张、支架置入或两者联合的PTM是原位肝移植（OLT）后治疗吻合口BS的一种安全方法，5年二次通畅率为88%。
