摘要
目的评价经内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)下放置全覆膜自膨式可回收金属支架(fully-covered self-expandable metal stents,FCSEMS)治疗肝移植术后胆管吻合口狭窄(anastomotic biliary strictures,ABSs)的效果。方法采用回顾性横断面研究方法,收集2015年1月至2017年4月首都医科大学附属北京佑安医院行肝移植(166例次肝移植)术后(3~60个月)出现ABSs、并于北京大学第一医院外科内镜中心进行内镜下FCSEMS治疗的12例病人资料,统计手术成功率、临床缓解率和并发症发生率等,总结及评价FCSEMS治疗肝移植术后ABSs的安全性及有效性。结果 12例病人中,接受FCSEMS治疗14例次获得成功:其中2例病人术后经2次支架治疗。1例病人内镜插管失败,结合经皮肝穿刺胆管引流(percutaneous transhepatic biliary drainage,PTCD)穿刺通过导丝插管成功,手术成功率为92.8%(13/14);临床缓解率为100%;术后发生急性胰腺炎1例,高淀粉酶血症3例,手术并发症发生率为28.6%(4/14);12例病人支架取出顺利,均无支架脱落及支架移位;所有病人FCSEMS植入术后无严重的手术并发症及死亡发生。结论肝移植术后ABSs采用FCSEMS治疗,安全性及有效性均较高,可作为目前肝移植术后ABSs的一线治疗方法。
Objective To evaluate the efficacy of endoscopic retrograde cholangiopancreatography （ERCP） with fully-covered self-expandable metal stents （FCSEMS） in the treatment of anastomotic biliary strictures （ABSs） after liver transplantation.Methods The clinical data of 12 patients undergoing ERCP with FCSEMS for ABSs after liver transplantation in Beijing Youan Hospital Affiliated to Capital Medical University from January2015 to April 2017 were retrospectively analyzed.The surgical success rate,clinical remission rate and the incidence of complications were recorded.The safety and efficacy of FCSEMS in the treatment of ABSs after liver transplantation were summarized and evaluated.Results Twelve patients undergoing liver transplantation（0.5 to 60.0 months）were treated with FCSEMS for 14 times successfully.Two of the patients were treated with 2 stents,and 1 patient was given percutaneous transhepatic bile duct drainage （PTCD） puncture through the successful intubation of guide wire after failure in endoscopic intubation.The success rate was 92.8% （13/14） and the clinical effectiveness was 100%.One patient developed acute pancreatitis after surgery,3 patients had hyperamylasemia and the incidence of complications was 28.6% （4/14）.The patient＇s stent was removed smoothly without any stent shedding and stent displacement.All patients had no serious complication and death after FCSEMS implantation.Conclusions The safety and efficacy of FCSEMS in the treatment of ABSs after liver transplantation were high,which could be used as the first-line treatment of ABSs after liver transplantation.
作者
张海涛
边大鹏
冯秋实
王孟龙
Zhang Haitao;Bian Dapeng;Feng Qiushi;Wang Menglong(Department of General Surgery Center,Beijing Youan Hospital,Capital Medical University,Beij ing 100069,China)
出处
《腹部外科》
2018年第3期199-202,共4页
Journal of Abdominal Surgery
基金
北京市医管局重点医学专业(ZYLX201311)
关键词
肝移植术后
胆管吻合口狭窄
全覆膜自膨式可回收金属支架
After liver transplantation
anastomolic biliary strictures
fully covered self-ex-pandable metal stents
