经皮经肝胆道镜检查联合高频电刀切开治疗肝移植术后胆管狭窄。
One-step Percutaneous Transhepatic Cholangioscopy Combined With High-frequency Needle-knife Electrotomy in Biliary Strictures After Liver Transplantation.
机构信息
Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan.
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
出版信息
Surg Laparosc Endosc Percutan Tech. 2021 May 3;31(6):787-793. doi: 10.1097/SLE.0000000000000946.
BACKGROUND
Endoscopic management is the mainstay for biliary strictures after liver transplantation. However, this method is often failed in cases associated with hepatolithiasis or refractory strictures. The aim of this study is to investigate whether 1-step percutaneous transhepatic biliary cholangiography (PTC) combined with high-frequency needle-knife electrotomy can be an alternative method in biliary strictures after liver transplantation that could not be treated by endoscopic management.
METHODS
Clinical data of 14 patients suffering from biliary strictures after liver transplantation from June 2014 to January 2018 were retrospectively analyzed. One-step PTC combined with high-frequency needle-knife electrotomy was used to resolve the strictures.
RESULTS
One-step PTC was successfully performed in all 14 patients. In 10 of 12 (83.3%) patients with hepatolithiasis, the stones were removed completely. Stricture resolution was detected in 13 of 14 (92.9%) patients at first postoperative choledochoscopy. Three mild adverse events occurred (cholangitis, 2 patients; delayed hemobilia, 1 patient), but were resolved with conservative treatment. The follow-up after supporting catheter removal was 15.7±4.5 months. Only 1 patient (8.3%) had stone recurrence and no stenosis occurred during supporting-catheter-free follow-up.
CONCLUSIONS
One-step PTC combined with high-frequency needle-knife electrotomy seems to be a useful for treating biliary strictures after liver transplantation.
背景
内镜治疗是肝移植后胆道狭窄的主要治疗方法。然而，对于伴有肝胆管结石或难治性狭窄的病例，该方法往往失败。本研究旨在探讨对于内镜治疗失败的肝移植后胆道狭窄，是否可以采用经皮经肝胆道造影（PTC）联合高频电刀切开作为一种替代方法。
方法
回顾性分析 2014 年 6 月至 2018 年 1 月 14 例肝移植后胆道狭窄患者的临床资料。采用经皮经肝胆道造影（PTC）联合高频电刀切开治疗胆道狭窄。
结果
14 例患者均成功完成了 PTC。12 例（83.3%）肝胆管结石患者中，10 例结石完全清除。术后第 1 次胆道镜检查发现 13 例（92.9%）狭窄缓解。3 例出现轻度不良事件（胆管炎 2 例，迟发性出血 1 例），但经保守治疗后缓解。支撑导管拔除后的随访时间为 15.7±4.5 个月。仅 1 例（8.3%）患者出现结石复发，在无支撑导管随访期间无狭窄发生。
结论
经皮经肝胆道造影（PTC）联合高频电刀切开术似乎是治疗肝移植后胆道狭窄的一种有效方法。
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