经皮经肝胆道镜检查在肝移植术后胆道并发症治疗中的有效性

Efficiency of percutaneous transhepatic cholangioscopy in the treatment of biliary complications after liver transplantation.

作者信息

Yasen Aimaiti, Feng Jun, Liang Run-Bin, Zhu Can-Hua, Li Jun, Liu An-Zhong, Liu Yan-Min, Wang Guo-Ying

机构信息

Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China.

出版信息

HPB (Oxford). 2023 Apr;25(4):463-471. doi: 10.1016/j.hpb.2023.01.010. Epub 2023 Jan 25.

DOI:10.1016/j.hpb.2023.01.010

PMID:36746707

Abstract

BACKGROUND

Percutaneous transhepatic cholangioscopy (PTCS) has provided an alternative therapeutic option for handling refractory biliary complications in liver transplanted recipients. This study aimed to evaluate short-term PTCS efficiency in the management of biliary complications following liver transplantation.

METHODS

Clinical data of 25 patients who received therapeutic PTCS due to biliary complications after liver transplantation were retrospectively analyzed.

RESULTS

Therapeutic PTCS was successfully performed in 25 patients. Biliary complications were anastomotic strictures in seven cases, intrahepatic cholangiolithiasis in four cases, extra-and intrahepatic cholangiolithiasis in three cases, choledocholithiasis complicated with anastomotic strictures in four cases, intrahepatic cholangiolithiasis complicated with non-anastomotic strictures in one case, intrahepatic cholangiolithiasis complicated with anastomotic strictures in five cases, intrahepatic cholangiolithiasis complicated with anastomotic strictures and ischemic cholangitis in one case. The median time between liver transplantation and first PTCS was 24 months, and median times of PTCS was 2.6. Clinical manifestations were significantly improved in most patients after PTCS, and biliary complications were successfully managed through PTCS in 15 cases, which were partially effective in eight cases and ineffective in two cases. PTCS was more effective in tackling anastomotic strictures and cholangiolithiasis.

CONCLUSION

PTCS was an effective therapeutic modality for treating refractory biliary complications following liver transplantation.

摘要

背景

经皮经肝胆道镜检查（PTCS）为肝移植受者难治性胆道并发症的处理提供了一种替代治疗选择。本研究旨在评估肝移植术后胆道并发症管理中PTCS的短期疗效。

方法

回顾性分析25例肝移植术后因胆道并发症接受治疗性PTCS的患者的临床资料。

结果

25例患者均成功进行了治疗性PTCS。胆道并发症包括吻合口狭窄7例、肝内胆管结石4例、肝内外胆管结石3例、胆总管结石合并吻合口狭窄4例、肝内胆管结石合并非吻合口狭窄1例、肝内胆管结石合并吻合口狭窄5例、肝内胆管结石合并吻合口狭窄及缺血性胆管炎1例。肝移植至首次PTCS的中位时间为24个月，PTCS的中位次数为2.6次。大多数患者PTCS后临床表现明显改善，15例通过PTCS成功处理了胆道并发症，8例部分有效，2例无效。PTCS在处理吻合口狭窄和胆管结石方面更有效。