Lisotti Andrea, Fusaroli Pietro, Caletti Giancarlo
Andrea Lisotti, Unità Operativa di Gastroenterologia, Ospedale Nuovo di Imola, 40026 Imola, Italy.
World J Hepatol. 2015 Dec 28;7(30):2927-32. doi: 10.4254/wjh.v7.i30.2927.
The clinical outcome of patients receiving liver transplantation could be significantly affected by biliary complications, including strictures, leaks, stones and bilomas; early diagnosis and treatment of these conditions lead to markedly reduction in morbidity and mortality. Therapeutic gold standard is represented by conservative approaches, both endoscopic and percutaneous, based on the type of biliary reconstruction, the local availability of the procedures and specific expertise. In patients with previous transplantation, the difficult biliary access and the possible presence of concomitant complications (mainly strictures) further restrict the efficacy of the endoscopic and percutaneous treatments; on the other hand, surgery should generally be avoided because of the even increased morbidity and mortality due to technical and clinical issues. Here we review the most common biliary complications occurring after liver transplantation and discuss available treatment options including future perspectives such as endoscopic ultrasound-guided biliary access in patients with Roux-en-Y choledocho-jejunostomy or extracorporeal shock wave lithotripsy for difficult stones.
接受肝移植患者的临床结局可能会受到胆道并发症的显著影响，这些并发症包括狭窄、渗漏、结石和胆汁瘤；对这些病症的早期诊断和治疗可显著降低发病率和死亡率。治疗的金标准是以保守方法为代表，包括内镜和经皮治疗，具体取决于胆道重建的类型、这些操作在当地的可获得性以及特定的专业技能。对于既往接受过移植的患者，胆道通路困难以及可能存在的伴随并发症（主要是狭窄）进一步限制了内镜和经皮治疗的疗效；另一方面，由于技术和临床问题导致发病率和死亡率甚至更高，通常应避免手术。在此，我们回顾肝移植后最常见的胆道并发症，并讨论现有的治疗选择，包括未来的展望，如在接受 Roux-en-Y 胆总管空肠吻合术的患者中进行内镜超声引导下的胆道通路建立，或对难处理的结石进行体外冲击波碎石术。
