Feller R B, Waugh R C, Selby W S, Dolan P M, Sheil A G, McCaughan G W
A.W. Morrow Gastroenterology & Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
J Gastroenterol Hepatol. 1996 Jan;11(1):21-5. doi: 10.1111/j.1440-1746.1996.tb00005.x.
We retrospectively examined 154 adults to ascertain the frequency, site of and pre-disposing factors for biliary strictures after liver transplantation, as well as their management and clinical outcome. Twenty patients (12.5%) were identified with biliary strictures; 16 were non-anastomotic and four were anastomotic strictures. The median time from transplantation to stricture diagnosis was 17 weeks (range 3-366). Of the 16 non-anastomotic strictures, six were intrahepatic, eight hilar and two extrahepatic (donor bile duct). A control group (n = 32) of patients transplanted immediately before and after index cases was used to examine for correlates in patients with non-anastomotic strictures. At the time of diagnosis in the non-anastomotic index cases, there was a higher incidence of: (i) biliary sludge (63 vs 0%; P < 0.001); and (ii) clinical cholangitis (75 vs 0%; P < 0.001) compared with controls. Primary sclerosing cholangitis was more often the diagnosis in index patients with non-anastomotic strictures compared with controls (31 vs 9%; P < 0.05). There were no differences between index patients and controls (non-anastomotic group) in ABO blood group non-identity, cold allograft ischaemia time, use of OKT3 (murine monoclonal antibody to CD3) and hepatic artery thrombosis. Of 15 patients treated with balloon dilatation, seven required stent insertion although none have required surgery. As determined by liver function tests, there was evidence of persisting graft dysfunction in index patients compared with controls (SAP 381 vs 112 U/L, P < 0.001; GGT 529 vs 80 U/L, P < 0.001), but there was no difference in survival during a median follow-up time of 16 months (range: 3-48 months) from stricture diagnosis. In conclusion, biliary strictures tend to occur within 6 months of transplantation and are an important cause of ongoing graft dysfunction. Non-anastomotic strictures were more common in patients requiring transplantation for primary sclerosing cholangitis.
我们回顾性研究了154例成人患者，以确定肝移植术后胆道狭窄的发生率、部位、易感因素，以及其处理方法和临床结局。20例患者（12.5%）被确诊为胆道狭窄；16例为非吻合口狭窄，4例为吻合口狭窄。从移植到狭窄诊断的中位时间为17周（范围3 - 366周）。在16例非吻合口狭窄中，6例为肝内型，8例为肝门型，2例为肝外型（供体胆管）。选取在索引病例前后立即进行移植的患者作为对照组（n = 32），以研究非吻合口狭窄患者的相关因素。在非吻合口索引病例诊断时，与对照组相比，以下情况的发生率更高：（i）胆泥（63% 对0%；P < 0.001）；（ii）临床胆管炎（75% 对0%；P < 0.001）。与对照组相比，原发性硬化性胆管炎在非吻合口狭窄的索引患者中更常被诊断出来（31% 对9%；P < 0.05）。在ABO血型不合、冷缺血时间、使用OKT3（抗CD3鼠单克隆抗体）和肝动脉血栓形成方面，索引患者与对照组（非吻合口组）之间没有差异。在15例接受球囊扩张治疗的患者中，7例需要置入支架，不过均未需要手术治疗。根据肝功能检查，与对照组相比，索引患者存在移植肝功能持续异常的证据（血清碱性磷酸酶381对112 U/L，P < 0.001；γ-谷氨酰转肽酶529对80 U/L，P < 0.001），但从狭窄诊断开始的中位随访时间16个月（范围：3 - 48个月）内，生存率没有差异。总之，胆道狭窄倾向于在移植后6个月内发生，并且是移植肝功能持续异常的重要原因。非吻合口狭窄在因原发性硬化性胆管炎而需要移植的患者中更为常见。
