Rieber A, Brambs H J, Lauchart W
Department of Diagnostic Radiology, University of Ulm, Robert-Koch-Strasse 8, D-89081 Ulm, Germany.
Cardiovasc Intervent Radiol. 1996 Jul-Aug;19(4):242-7. doi: 10.1007/BF02577643.
Biliary complications contribute significantly to morbidity and mortality in the liver transplant recipient. Surgery has been the mainstay of therapy, but interventional radiological techniques have made significant progress.
Diagnostic percutaneous transhepatic cholangiography (PTC) was performed in 12 patients; percutaneous transhepatic drainage (PTD) was performed in 10 patients. Additional interventional procedures included laser lithotripsy, biopsy, dilatation, and stent implantation.
In 6 patients PTC revealed anastomotic, and in 6 patients nonanastomotic biliary strictures. Four patients had intrahepatic stones. Biliary strictures were treated by implantation of Palmaz stents in 5 of 6 patients with anastomotic strictures, and in 3 of 6 patients with nonanastomotic strictures. The intrahepatic stones were fragmented with dye laser lithotripsy under cholangioscopic control in 3 of 4 patients. One spontaneous stent migration after 24 months and one stent occlusion were observed; the remaining stents are still patent. Patients with anastomotic strictures had a more favorable outcome: 5 of 6 of these patients are still alive and symptom-free after an average of 27.4 months, but only 3 of 6 patients with nonanastomotic strictures are alive after an average of 9.8 months.
The different outcomes in patients with anastomotic versus nonanastomotic strictures may be explained by the different causes of these types of stricture.
胆道并发症对肝移植受者的发病率和死亡率有重大影响。手术一直是主要的治疗方法，但介入放射技术已取得显著进展。
对12例患者进行了诊断性经皮经肝胆管造影（PTC）；对10例患者进行了经皮经肝引流（PTD）。其他介入操作包括激光碎石术、活检、扩张和支架植入。
6例患者PTC显示吻合口狭窄，6例患者显示非吻合口胆管狭窄。4例患者有肝内结石。6例吻合口狭窄患者中有5例、6例非吻合口狭窄患者中有3例通过植入帕尔马支架治疗胆管狭窄。4例患者中有3例在胆道镜控制下用染料激光碎石术破碎肝内结石。观察到1例支架在24个月后自发移位和1例支架闭塞；其余支架仍通畅。吻合口狭窄患者的预后较好：这些患者中有5例在平均27.4个月后仍存活且无症状，但6例非吻合口狭窄患者中只有3例在平均9.8个月后存活。
吻合口狭窄与非吻合口狭窄患者的不同预后可能由这些类型狭窄的不同原因来解释。
