胆管造影特征及胆管狭窄的内镜治疗
Cholangiographic features and endoscopic treatment of biliary strictures.
作者信息
Cai Xiaobo, Liu Feng, Zhu Feng, Zhang Ruling, Zhou Hui, Wan Xinjian
机构信息
Department of Gastroenterology, First People's Hospital, Shanghai Jiaotong University, School of Medicine Shanghai 200080, China.
Department of Gastroenterology, Changhai Hospital, Second Military Medical University Shanghai 200433, China.
出版信息
Int J Clin Exp Med. 2015 Feb 15;8(2):2586-92. eCollection 2015.
OBJECTIVES
The most commonly occurring complications following orthotopic liver transplantation procedures are associated with the biliary tract. Endoscopic technique has become the primary modality for the treatment of biliary strictures after liver transplantation. The objective of this study was to assess the role of cholangiographic features of the initial cholangiogram in endoscopic treatment success and stricture recurrence.
METHODS
Patients who underwent endoscopic therapy for biliary strictures after orthotopic liver transplantation (OLT), from 2006 to 2009 were included in this retrospective study.
RESULTS
The initial success rate after endoscopic treatment was achieved in 85.53% patients. However, recurrence of biliary strictures occurred in 24.62% of the patients. Patients with successful anastomotic biliary strictures (AS) after treatment were characterized by shorter stricture length as compared to patients who have not achieved success (p < 0.01). Of the 42 patients with AS, patients with recurrence had larger initial stricture length (p < 0.01) and smaller narrowing diameter (p < 0.01) than those without recurrence. Patients treated with NAS for multiple strictures experienced increased rate of recurrence than those with single narrowing, but failed to achieve statistical significance (50% vs. 23.08%, p = 0.18). Patients for whom dilation failed to eliminate the waist, experienced higher recurrence rate than those without stricture waist (70% vs. 16.63%, p < 0.01).
CONCLUSIONS
Endoscopic procedure using endoscopic retrograde cholangiopancreatography was found to be an effective modality for treating biliary strictures after OLT.
目的
原位肝移植术后最常见的并发症与胆道相关。内镜技术已成为肝移植术后胆道狭窄治疗的主要方式。本研究的目的是评估初始胆管造影的胆管造影特征在内镜治疗成功及狭窄复发中的作用。
方法
本回顾性研究纳入了2006年至2009年接受原位肝移植（OLT）术后胆道狭窄内镜治疗的患者。
结果
85.53%的患者在内镜治疗后获得了初始成功率。然而，24.62%的患者出现了胆道狭窄复发。治疗后吻合口胆道狭窄（AS）成功的患者，与未成功的患者相比，狭窄长度较短（p < 0.01）。在42例AS患者中，复发患者的初始狭窄长度较大（p < 0.01），狭窄直径较小（p < 0.01），与未复发患者相比。接受NAS治疗多处狭窄的患者复发率高于单处狭窄患者，但未达到统计学意义（50%对23.08%，p = 0.18）。扩张未能消除腰部的患者，复发率高于无狭窄腰部的患者（70%对16.63%，p < 0.01）。
结论
使用内镜逆行胰胆管造影的内镜手术被发现是治疗OLT术后胆道狭窄的有效方式。
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