Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
J Gastroenterol. 2013 Sep;48(9):1097-104. doi: 10.1007/s00535-012-0705-x. Epub 2013 Jan 17.
Biliary complications are one of the most serious morbidities after liver transplantation. Inside-stent is a plastic stent placed above the sphincter of Oddi without endoscopic sphincterotomy against biliary strictures. Our aims were to analyze the long-term efficacy of inside-stent placement in patients with biliary stricture after living donor liver transplantation.
Ninety-four patients who experienced biliary stricture that employed duct-to-duct reconstruction were treated with inside-stent placement. Treatment outcomes, including stricture resolution, recurrence, inside-stent patency, and morbidity rate were evaluated retrospectively.
Ninety-two patients could be evaluated. Resolution of stricture was eventually observed in 81 of 92 patients with an average of 1.4 sessions of endoscopic retrograde cholangiography. Of the 81 patients who achieved the resolution of the stricture, recurrent biliary stricture that required intervention occurred in 8 patients. Conversely, stricture remission was achieved 73 patients (90.1 %) during 53 months follow-up after stent removal. Median duration of patency of the initial stent was 189 (range 2-1228) days. Stent dislocation occurred in 10 patients. Adverse event related to inside-stent placement was pancreatitis in 18 cases (mild 13, moderate 5).
Inside-stent placement achieved long-term patency and high remission rate in patients with biliary stricture after liver transplantation.
胆管并发症是肝移植后最严重的并发症之一。内支架是一种在奥狄氏括约肌上方放置的塑料支架，无需内镜下括约肌切开术即可治疗胆管狭窄。我们的目的是分析内支架置入治疗活体肝移植后胆管狭窄患者的长期疗效。
94 例因胆肠吻合术后发生胆管狭窄而行胆管内支架置入术的患者，回顾性分析其治疗效果，包括狭窄缓解、复发、内支架通畅率和并发症发生率。
92 例患者可进行评估。81 例患者（88.0%）在平均 1.4 次逆行胰胆管造影后最终观察到狭窄缓解。在 81 例狭窄缓解的患者中，8 例患者出现需要介入治疗的复发性胆管狭窄。相反，在支架取出后 53 个月的随访中，73 例患者（90.1%）狭窄缓解。初次支架通畅时间的中位数为 189（范围 2-1228）天。10 例患者发生支架移位。与内支架放置相关的不良事件有 18 例胰腺炎（轻度 13 例，中度 5 例）。
内支架置入术可使肝移植后胆管狭窄患者获得长期通畅和高缓解率。
