*Department of Surgery, The University of Hong Kong, Hong Kong, China †State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China.
Ann Surg. 2014 Apr;259(4):767-72. doi: 10.1097/SLA.0b013e318294d0ce.
This aim of this study is to determine the risk factors in failed endoscopic retrograde cholangiography (ERC).
Endoscopic treatment is considered the first-line intervention for biliary anastomotic stricture (BAS) after right-lobe living donor liver transplantation with duct-to-duct anastomosis.
A retrospective study was performed on 287 patients who received right-lobe living donor liver transplantation with duct-to-duct anastomosis. The morphology of BAS was defined according to the shape of the distal side of duct-to-duct anastomosis shown on cholangiogram and was categorized into 3 types: pouched, intermediately pouched, and triangular. All cases of ERC were performed by operating surgeons.
Fifty-nine patients (20.6%) had BAS and received ERC and balloon dilatation with or without stenting. The success rate was 73.2%. The median number of sessions needed for successful ERC was 3. In the 15 patients with failed ERC, 4 were successfully treated with percutaneous transhepatic biliary drainage and balloon dilatation and 11 underwent conversion hepaticojejunostomy (6 had external percutaneous transhepatic biliary drainage as a temporizing measure). On multivariate analysis, recipient age [odds ratio (OR): 0.922; 95% confidence interval (CI): 0.85-1.00; P = 0.049], operation time (OR: 1.007; 95% CI: 1.001-1.013; P = 0.025), and morphology of stricture (OR: 6.722; 95% CI: 1.31-34.48; P = 0.022) were independent risk factors associated with failed ERC. The success rates for the 3 types of BAS-pouched, intermediately pouched, and triangular-were 42.9%, 63.6%, and 88.9%, respectively (P = 0.021). Association was found between bile leak and pouched BAS (P = 0.008).
ERC is highly effective in treating BAS. A success rate of 73%, the highest ever reported, has been achieved. Morphology of stricture is associated with outcome of ERC. Radiological or surgical intervention should be considered for patients with pouched BAS after endoscopic treatment fails for the first time.
本研究旨在确定内镜逆行胆胰管造影（ERC）失败的相关危险因素。
对于右叶活体供肝移植后胆管对胆管吻合的胆肠吻合口狭窄（BAS），内镜治疗被认为是一线干预措施。
对 287 例行胆管对胆管吻合的右叶活体供肝移植患者进行回顾性研究。根据胆造影显示的胆管对胆管吻合远端的形态，将 BAS 的形态分为 3 型：囊状、中间囊状和三角形。所有 ERC 均由手术医生进行。
59 例（20.6%）患者发生 BAS，行 ERC 及球囊扩张术，其中 52 例行支架置入，成功率为 73.2%。成功行 ERC 所需的中位次数为 3 次。在 15 例 ERC 失败的患者中，4 例经皮经肝胆道引流和球囊扩张成功治疗，11 例行胆肠吻合术（6 例在临时措施中经皮经肝胆道引流）。多因素分析显示，受者年龄[比值比（OR）：0.922；95%置信区间（CI）：0.85-1.00；P=0.049]、手术时间（OR：1.007；95%CI：1.001-1.013；P=0.025）和狭窄形态（OR：6.722；95%CI：1.31-34.48；P=0.022）是与 ERC 失败相关的独立危险因素。3 种 BAS 形态（囊状、中间囊状和三角形）的成功率分别为 42.9%、63.6%和 88.9%（P=0.021）。胆漏与囊状 BAS 相关（P=0.008）。
ERC 治疗 BAS 非常有效，成功率高达 73%，为目前报道的最高水平。狭窄形态与 ERC 结果相关。对于内镜治疗首次失败的囊状 BAS 患者，应考虑行放射学或手术干预。
