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[非血管介入放射学在肝移植术后并发症治疗中的应用。临床与放射学相关性及技术考量]

[Nonvascular interventional radiology in the treatment of post-liver transplant complications. The clinico-radiological correlations and technical considerations].

作者信息

Rossi M, Salvatori F M, Ingianna D, Greco M, Iappelli M, Rossi P

机构信息

III Cattedra, Istituto di Radiologia, Università degli Studi di Roma La Sapienza.

出版信息

Radiol Med. 1995 Sep;90(3):291-7.

PMID:7501836
Abstract

Eleven patients, included in a series of 105 orthotopic liver transplant recipients, underwent interventional radiologic procedures for post-operative complications. Seven patients had obstructive jaundice, three patients had sepsis, and one patient was bleeding from the T-tube. Cholangiography, performed in 9/11 patients, demonstrated stenosis of the anastomosis in six cases, stenosis of the intrahepatic biliary tree in one case, and stenosis of both tracts in the remaining two cases. Four patients were treated with bilioplasty (from 1 to 5 sessions), using balloon catheters (8-10 mm) followed by stones removal in one case, and by the placement of a metallic stent in another case. The follow-up ranged from one to three years: no biliary stasis occurred, during that period, in these patients. Another patient with recurrent cholangiocarcinoma of the biliary anastomosis, treated with Carey-Coons endoprosthesis and brachytherapy, died four months later without jaundice. In the three patients with sepsis and in the patient with bleeding from the T-tube, intra- or extra-hepatic (in one case) multiple abscesses were demonstrated. The conservative treatment with the placement of percutaneous drainage catheters, associated with internal biliary drainage in two cases, allowed complete symptoms resolution. The technical success obtained in all patients confirmed the effectiveness of interventional radiology in the treatment of biliary complications after liver transplant, thus avoiding the need of surgical reintervention.

摘要

在105例原位肝移植受者中,有11例因术后并发症接受了介入放射学治疗。7例患者出现梗阻性黄疸,3例患者发生脓毒症,1例患者T管出血。11例患者中有9例行胆管造影,其中6例显示吻合口狭窄,1例显示肝内胆管树狭窄,其余2例显示两处均狭窄。4例患者接受了胆管成形术(1至5次),使用球囊导管(8 - 10毫米),其中1例随后进行了取石,另1例放置了金属支架。随访时间为1至3年:在此期间,这些患者未发生胆汁淤积。另1例胆管吻合口复发性胆管癌患者接受了凯里 - 库恩斯内假体和近距离放射治疗,4个月后无黄疸死亡。在3例脓毒症患者和1例T管出血患者中,显示有肝内或肝外(1例)多发性脓肿。经皮引流导管置入的保守治疗,2例联合胆道内引流,使症状完全缓解。所有患者获得的技术成功证实了介入放射学在治疗肝移植术后胆道并发症方面的有效性,从而避免了再次手术干预的需要。

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