Boeva Irina, Karagyozov Petko Ivanov, Tishkov Ivan
Department of Interventional Gastroenterology, Acibadem City Clinic Tokuda Hospital, Sofia 1407, Bulgaria.
Department of Interventional Gastroenterology, Clinic of Gastroenterology, Acibadem City Clinic Tokuda Hospital, Sofia 1407, Bulgaria.
World J Hepatol. 2021 Jan 27;13(1):66-79. doi: 10.4254/wjh.v13.i1.66.
Liver transplantation is the current standard of care for end-stage liver disease and an accepted therapeutic option for acute liver failure and primary liver tumors. Despite the remarkable advances in the surgical techniques and immunosuppressive therapy, the postoperative morbidity and mortality still remain high and the leading causes are biliary complications, which affect up to one quarter of recipients. The most common biliary complications are anastomotic and non-anastomotic biliary strictures, leaks, bile duct stones, sludge and casts. Despite the absence of a recommended treatment algorithm many options are available, such as surgery, percutaneous techniques and interventional endoscopy. In the last few years, endoscopic techniques have widely replaced the more aggressive percutaneous and surgical approaches. Endoscopic retrograde cholangiography is the preferred technique when duct-to-duct anastomosis has been performed. Recently, new devices and techniques have been developed and this has led to a remarkable increase in the success rate of minimally invasive procedures. Understanding the mechanisms of biliary complications helps in their early recognition which is the prerequisite for successful treatment. Aggressive endoscopic therapy is essential for the reduction of morbidity and mortality in these cases. This article focuses on the common post-transplant biliary complications and the available interventional treatment modalities.
肝移植是终末期肝病当前的标准治疗方法，也是急性肝衰竭和原发性肝肿瘤公认的治疗选择。尽管手术技术和免疫抑制治疗取得了显著进展，但术后发病率和死亡率仍然很高，主要原因是胆道并发症，多达四分之一的受者会受到影响。最常见的胆道并发症是吻合口和非吻合口胆管狭窄、渗漏、胆管结石、胆泥和胆栓。尽管缺乏推荐的治疗方案，但有多种选择，如手术、经皮技术和介入性内镜检查。在过去几年中，内镜技术已广泛取代了更具侵入性的经皮和手术方法。当进行胆管对胆管吻合时，内镜逆行胆管造影是首选技术。最近，新的设备和技术不断涌现，这使得微创手术的成功率显著提高。了解胆道并发症的机制有助于早期识别，而早期识别是成功治疗的前提。积极的内镜治疗对于降低这些病例的发病率和死亡率至关重要。本文重点关注常见的移植后胆道并发症及可用的介入治疗方式。
