Alves Ana Rita, Gomes Dário, Furtado Emanuel, Tomé Luís
Serviço de Gastrenterologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
GE Port J Gastroenterol. 2018 Jan;25(1):10-17. doi: 10.1159/000480704. Epub 2017 Oct 11.
Biliary tract complications following liver transplant remain an important source of morbidity and mortality. Endoscopic retrograde cholangiopancreatography (ERCP) has become a common therapeutic option before other invasive procedures. The aim of this study was to evaluate ERCP efficacy in managing this type of complications.
Retrospective study of all patients who underwent therapeutic ERCP due to post-liver transplant biliary complications between September 2005 and September 2015, at a deceased donor liver transplantation centre.
Therapeutic ERCP was performed in 120 patients (64% men; mean age 46 ± 14 years). Biliary complications were anastomotic strictures (AS) in 70%, non-anastomotic strictures (NAS) in 14%, bile leaks (BL) in 5.8%, and bile duct stones (BDS) in 32%. The mean time between liver transplant and first ERCP was: 19 ± 30 months in AS, 17 ± 30 months in NAS, 61 ± 28 months in BDS, and 0.7 ± 0.6 months in BL ( < 0.001). The number of ERCP performed per patient was: 3.8 ± 2.4 in AS, 3.8 ± 2.1 in NAS, 1.9 ± 1 in BDS, and 1.9 ± 0.5 in BL ( = 0.003). The duration of the treatment was: 18 ± 19 months in AS, 21 ± 17 months in NAS, 10 ± 10 months in BDS, and 4 ± 3 months in BL ( = 0.064). Overall, biliary complications were successfully managed by ERCP in 46% of cases, either as an isolated procedure (43%) or rendez-vous ERCP (3%). Per complication, ERCP was effective in 39% of AS, in 12% of NAS, in 91% of BDS, and in 86% of BL. Globally, the mean follow-up of the successful cases was 43 ± 31 months. Percutaneous transhepatic cholangiography and/or surgery were performed in 48% of patients in whom ERCP was unsuccessful. The odds ratio for effective endoscopic treatment was 0.2 for NAS (0.057-0.815), 12.4 for BDS (1.535-100.9), and 6.9 for BL (0.798-58.95). No statistical significance was found for AS ( = 0.247).
ERCP allowed the treatment of biliary complication in about half of patients, avoiding a more invasive procedure. Endoscopic treatment was more effective for BDS and BL.
肝移植术后胆道并发症仍是发病和死亡的重要原因。在其他侵入性操作之前，内镜逆行胰胆管造影术（ERCP）已成为一种常见的治疗选择。本研究的目的是评估ERCP在处理这类并发症方面的疗效。
对2005年9月至2015年9月间在一家尸体供肝肝移植中心因肝移植术后胆道并发症接受治疗性ERCP的所有患者进行回顾性研究。
120例患者接受了治疗性ERCP（64%为男性；平均年龄46±14岁）。胆道并发症中，吻合口狭窄（AS）占70%，非吻合口狭窄（NAS）占14%，胆漏（BL）占5.8%，胆管结石（BDS）占32%。肝移植与首次ERCP之间的平均时间为：AS组19±30个月，NAS组17±30个月，BDS组61±28个月，BL组0.7±0.6个月（<0.001）。每位患者进行ERCP的次数为：AS组3.8±2.4次，NAS组3.8±2.1次，BDS组1.9±1次，BL组1.9±0.5次（=0.003）。治疗持续时间为：AS组18±19个月，NAS组21±17个月，BDS组10±10个月，BL组4±3个月（=0.064）。总体而言，46%的病例通过ERCP成功处理了胆道并发症，要么作为单独的操作（43%），要么作为会师ERCP（3%）。每种并发症中，ERCP在39%的AS病例、12%的NAS病例、91%的BDS病例和86%的BL病例中有效。总体而言，成功病例的平均随访时间为43±31个月。48% ERCP未成功的患者接受了经皮肝穿刺胆管造影和/或手术。NAS内镜治疗有效的优势比为0.2（0.057 - 0.815），BDS为12.4（1.535 - 100.9），BL为6.9（0.798 - 58.95）。AS组未发现统计学意义（=0.247）。
ERCP使约一半的患者的胆道并发症得到治疗，避免了更具侵入性的操作。内镜治疗对BDS和BL更有效。
