天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (5): 518-521.doi: 10.11958/20160303

• 专题研究-消化疾病 • 上一篇    下一篇

ERCP 对肝移植术后胆漏的诊疗效果评价

李文 1， 2△， 董默 1， 2， 李彦茹 3， 张浩 2， 索宗武 2   

  1. 1天津市人民医院内镜诊疗中心 （邮编300121）， 2普外科； 3天津中医药大学研究生院
  • 收稿日期:2016-04-15 修回日期:2016-05-03 出版日期:2016-05-15 发布日期:2016-05-18
  • 通讯作者: △通讯作者 E-mail： drliwen@126.com E-mail:drliwen@126.com
  • 作者简介:李文 （1962）， 女， 主任医师， 教授， 主要从事胃肠及肝胆外科、 消化内镜对消化疾病诊疗工作， 尤其擅长ERCP对胆胰疾病的诊断 及微创治疗等相关研究

The evaluation of diagnosis and treatment effects of ERCP in bile leaks following orthotopic liver transplantation

LI Wen1,2△, DONG Mo1,2, LI Yanru3, ZHANG Hao2, SUO Zongwu2   

  1. 1 Endoscopy Centre, 2 Department of General Surgery, Tianjin Union Medicine Centre,
    Tianjin 300121, China； 3 Tianjin University of Traditional Chinese Medicine
  • Received:2016-04-15 Revised:2016-05-03 Published:2016-05-15 Online:2016-05-18
  • Contact: △Corresponding Author E-mail： drliwen@126.com E-mail:drliwen@126.com

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摘要： 摘要： 目的 评估经内镜逆行胰胆管造影术（ERCP）在原位肝移植术（OLT）后对胆漏的诊疗作用。方法 回顾 分析我院 2013 年 3 月—2016 年 2 月间共 12 例 OLT 术后经临床、 磁共振胰胆管成像术（MRCP）或术中 ERCP 证实 为胆漏患者的资料， 包括胆漏及其合并症的临床症状、 发生时间、 发生部位、 诊疗过程、 疗效等临床资料， 评价 ERCP 的诊疗价值。结果 本组 12 例均为男性， 年龄 35~62 岁， 平均（49.75±8.55）岁。11 例成功行经内镜鼻胆管引流术 （ENBD）， 成功率 91.7%； 胆漏治愈率 91.7% （11/12）； 无 ERCP 相关严重并发症及死亡病例发生； 其中 9 例合并胆管狭 窄和 （或） 伴胆管结石/胆栓者在进行初次 ERCP 诊疗时行内镜下十二指肠乳头括约肌切开术 （EST）， 并于胆漏愈合 2 周后行进一步 ERCP 治疗。除 1 例 ENBD 未成功者外， 其余随访效果良好。结论 ERCP 是 OLT 术后不同类型胆 漏的安全及有效的微创治疗方法。

关键词: 胰胆管造影术, 内窥镜逆行, 肝移植, 经内镜逆行性胆胰管造影术, 胆漏, 胆道并发症, 经内镜鼻胆管引 流术

Abstract: Abstract： Objective To evaluate the curative efficacy of endoscopic retrograde cholangiopancreatography (ERCP) on bile leaks after orthotopic liver transplantation (OLT). Methods Data of 12 cases, hospitalized in our hospital from March 2013 to February 2016, with bile leaks after OLT confirmed by magnetic resonance imaging of the pancreas (MRCP) or ERCP were retrospectively analyzed . The curative efficacy of ERCP was evaluated including clinical symptoms of bile leaks and complications, occurrence time and location, diagnosis and treatment process and efficacy. Results In this study, 12 cases were male patients, with the average age of 49.75±8.55 (age from 35 to 62 years old). Among them 11 cases were successfully treated by endoscopic nasobiliary drainage (ENBD), and the success rate of endoscopical therapy was 91.7%, the curative rate of bile leaks was 91.7% (11/12). No ERCP related serious complications and death were found in patients. Nine cases combined with biliary strictures and/or biliary duct stone/bile plug were performed endoscopic sphinctrotomy (EST) during the first time of ERCP, and accepted further ERCP treatment after 2 weeks when the bile leaks were healed. All patients with ENBD were carried out well except one case. Conclusion ERCP is a safe and effective minimally invasive treatment method for different types of bile leaks after OLT.

Key words: cholangiopancreatography, endoscopic retrograde, liver transplantation, endoscopic retrogradecholangio? pancreatograph (ERCP), bile leaks, biliary complications, endoscopic nasobiliary drainage (ENBD)