Macfarlane B, Davidson B, Dooley J S, Dawson K, Osborne M J, Rolles K, Burroughs A K
Hepatobiliary and Liver Transplantation Unit, Royal Free Hospital and School of Medicine, London, UK.
Eur J Gastroenterol Hepatol. 1996 Oct;8(10):1003-6. doi: 10.1097/00042737-199610000-00013.
Biliary reconstruction in orthotopic liver transplantation is increasingly being performed without T tube drainage. This increases the difficulty of diagnosing subsequent biliary tract problems, with a greater reliance placed on endoscopic retrograde cholangiopancreatography (ERCP) for the diagnosis of biliary tract complications. The usefulness of ERCP was evaluated in patients who underwent liver transplant where biliary reconstruction was not done with T tube drainage.
A retrospective study of the case notes of 90 patients who underwent liver transplantation, and in whom the biliary reconstruction was by end to end choledochocholedochostomy without T tube splintage.
ERCP was performed as the primary procedure to investigate a suspected biliary complication in 30 patients (33%). The procedure was successful in 26 patients (87%), and showed a biliary stricture in 12 patients and a bile leak in six patients. ERCP was normal in seven patients and demonstrated dilated ducts alone in one patient. Six of the biliary strictures were successfully dilated endoscopically (50%), but none of the bile leaks resolved with endoscopic drainage.
This study confirms the diagnostic role of ERCP post liver transplant. The therapeutic role requires clearer evaluation with a controlled trial.
原位肝移植中的胆道重建越来越多地在不放置T管引流的情况下进行。这增加了诊断后续胆道问题的难度，更加依赖内镜逆行胰胆管造影（ERCP）来诊断胆道并发症。对未进行T管引流胆道重建的肝移植患者评估ERCP的效用。
对90例接受肝移植患者的病历进行回顾性研究，这些患者的胆道重建采用端端胆总管吻合术且未使用T管支撑。
30例患者（33%）将ERCP作为调查疑似胆道并发症的主要方法。该操作在26例患者中成功（87%），显示12例患者有胆道狭窄，6例患者有胆漏。7例患者ERCP结果正常，1例患者仅显示胆管扩张。6例胆道狭窄患者通过内镜成功扩张（50%），但没有一例胆漏通过内镜引流得到解决。
本研究证实了ERCP在肝移植后的诊断作用。其治疗作用需要通过对照试验进行更明确的评估。
