Thuluvath Paul J, Atassi Tamer, Lee John
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Liver Int. 2003 Jun;23(3):156-62. doi: 10.1034/j.1600-0676.2003.00823.x.
Biliary complications following orthotopic liver transplantation (OLT) may be associated with significant morbidity and mortality. In this report, we reviewed our endoscopic experience of managing post OLT biliary complications in 79 patients over a 12-year period.
OLT (n = 423) recipients between 10/86 and 12/98 were obtained from the transplant registry at the Johns Hopkins Hospital. OLT recipient who underwent at least one endoscopic retrograde cholangiography (ERC) were identified through a radiology database. Indications, findings and interventions performed were noted for each ERC report. Outpatient and inpatients medical records were reviewed for outcome and complications.
Seventy-nine (79/423, 18.7%) patients had at least one ERC for suspected biliary complication. Sixty-four (15.1%) patients had at least one or more biliary complications. The mean follow-up for patients with abnormal ERC was 33.9 months. Nineteen patients had bile leaks; 10 of these patients had leak at the exit site of the T-tube and five patients had at the anastomosis. Biliary stenting with or without endoscopic sphincterotomy led to resolution of bile leak in 16 patients. Three patients failed endoscopic therapy: one underwent surgery and two had percutaneous drainage. Twenty-five patients presented with biliary strictures. Nineteen strictures were at the anastomotic or just proximal to the anastomosis, one at the hilum (ischemic in nature) and three were at the distal, recipient common bile duct; one had strictures at the anastomosis as well as the distal recipient bile duct and another had diffuse intrahepatic strictures. Seventeen patients in the stricture group improved with endoscopic intervention. One patient was re-transplanted (diffuse intrahepatic strictures), but no patient underwent percutaneous drainage.
ERC is safe and effective in the diagnosis and management of biliary complications following liver transplantation with choledochocholedochal anastomosis and obviates the need for surgical or percutaneous transhepatic approaches in majority of cases.
原位肝移植（OLT）后的胆道并发症可能与显著的发病率和死亡率相关。在本报告中，我们回顾了12年间对79例患者进行OLT术后胆道并发症内镜治疗的经验。
1986年10月至1998年12月期间约翰霍普金斯医院移植登记处的OLT受者（n = 423）。通过放射学数据库确定至少接受过一次内镜逆行胆管造影（ERC）的OLT受者。记录每份ERC报告的指征、发现和进行的干预措施。查阅门诊和住院病历以了解结局和并发症情况。
79例（79/423，18.7%）患者因疑似胆道并发症至少接受过一次ERC。64例（15.1%）患者至少有一处或多处胆道并发症。ERC异常患者的平均随访时间为33.9个月。19例患者发生胆漏；其中10例患者在T管出口处漏胆，5例患者在吻合口处漏胆。有或无内镜下括约肌切开术的胆管支架置入术使16例患者的胆漏得到缓解。3例患者内镜治疗失败：1例接受手术，2例进行经皮引流。25例患者出现胆管狭窄。19处狭窄位于吻合口或吻合口近端，1处位于肝门（本质上为缺血性），3处位于远端受者胆总管；1例在吻合口以及远端受者胆管处有狭窄，另1例有弥漫性肝内狭窄。狭窄组17例患者经内镜干预后病情改善。1例患者再次移植（弥漫性肝内狭窄），但无患者接受经皮引流。
ERC在诊断和治疗胆总管对端吻合肝移植术后胆道并发症方面安全有效，在大多数情况下无需手术或经皮肝穿刺方法。
