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find Author "杨士明" 2 results
  • Endoscopic Observation and Treatment of Bile Duct Anastomotic Stricture and Biliary Injury Following Liver Transplantation

    ObjectiveTo discuss the relation between bile duct anastomotic stricture and bile duct injury by endo-scopic observation following liver transplantation and it, s efficacy of endoscopic treatment. Method The clinical data of 24 cases of bile duct anastomotic stricture following liver transplantation diagnosed by cholangiography were analyzed retro-spectively. Results①Twenty-four cases of bile duct anastomotic strictures were included in 3 cases of typeⅠa, 2 cases of typeⅠb, 4 cases of typeⅡ, 1 case of typeⅢa, 5 cases of typeⅢb, and 9 cases of typeⅢc.②The redness of intrahepatic bile duct mucosa, banding erosion, ulcer and fusion of anastomotic stricture mucosa could be seen in typeⅠa andⅢa. The redness of intrahepatic bile duct and anastomotic stricture mucosa could be seen in typeⅡwithout ulcer and fusion. The extensive erosion and ulcer of intrahepatic bile duct and redness of anastomotic stricture mucosa could be seen in typeⅢb. The extensive erosion, ulcer and partial necrosis of intrahepatic bile duct and anastomotic stricture mucosa could be seen in typeⅠb andⅢc.③Seventeen cases were cured by choledochoscopy through T tube, the biliary casts were moved out and the anastomotic strictures were relieved by balloon dilatation and placement of plastic stenting for 2 to 6 months, no recurrence happened. One case of typeⅠb treated by percutaneous transhepatic cholangial drainage(PTCD) and percuta-neous transhepatic cholangioscopy(PTCS) was developed into the stricture of typeⅡduring following-up for 19 months. Two cases of typeⅠa were treated by ERCP, the biliary casts were moved, one of which was cured, another 1 case was developed into the stricture of typeⅡduring following-up for 5 months. Two cases of typeⅡwere treated by ERCP, the biliary casts were moved, balloon dilatation and placement of plastic stent were performed, one of which was cured, another 1 case was recurrent during following-up for 1 months. The strictures were not relieved by multiple plastic stents for 4 to 6 months in 3 patients with recurrence and progress, but which was relieved by full-covered self-expanding removable metal stents for 4 to 7 months, there was no recurrence during following-up. One case of typeⅢb and one case of typeⅢc received the secondary open operation or choledochoscopy and placement of plastic stent for biliary infection and jaundice after the treatment of ERCP were cured. ConclusionsBiliary stricture following liver transplantation accompanies different degree biliary injury. The slightest is typeⅡand typeⅠa, typeⅢa is the second, typeⅢb is more serious, and typeⅠb and typeⅢc are the worst. Choledochoscopy is a better choose for anastomotic strictures. ERCP is not a better choose for anastomotic strictures of typeⅠb, Ⅲb, andⅢc.

    Release date:2021-06-24 01:08 Export PDF Favorites Scan
  • 持续性球囊扩张治疗胆肠吻合术后复发性吻合口狭窄

    目的探讨持续性球囊扩张治疗胆肠吻合术后复发性吻合口狭窄的价值。 方法回顾性分析持续性球囊扩张治疗的2例胆肠Roux-en-Y吻合术后复发性吻合口狭窄患者的临床资料。 结果2例患者分别接受直径6 mm球囊及8 mm球囊持续性扩张治疗;持续性球囊扩张术后第1天出现胆红素、转氨酶及胆管酶谱的显著升高,术后第3天明显降低,部分指标恢复正常;持续扩张5个月后行胆道镜观察,见吻合口肠黏膜移行良好,无充血水肿,吻合口周围组织柔软,未见瘢痕;胆道镜可顺利通过吻合口进入肝内,肝内胆管黏膜无充血水肿,未见淤积胆泥或复发结石。 结论持续性球囊扩张是姑息治疗胆肠吻合口狭窄的一种有效方法。

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