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胆管引流术联合熊去氧胆酸治疗肝移植术后胆管吻合口狭窄

发布日期:2014-10-22 12:49:41 文章来源:本站原创 作者次数:1298

    朱峰 宛新建 陆伦根 郑萍 李雷 罗声政

     

    【摘要】 目的分析胆管引流术联合熊去氧胆酸(商品名:优思弗)治疗肝移植术后胆管吻合口狭窄的临床疗效。方法35肝移植术后胆管吻合口狭窄患者(原发性肝癌21例,乙肝后肝硬化11例,原发性胆汁性肝硬化3例)随机分为两组:观察组18例,对照组17例。全部患者给予保肝、支持、抗感染治疗,并行ERC下胆管引流术(鼻胆管引流术或胆管支架置入术)。观察组同时联合应用UDCA 1015 mg. kg1.d1,疗程1个月。结果35例中6例行鼻胆管引流术,17例行胆管内单支架引流术,12例行胆管双支架引流术。观察组患者术后14天、30天血清胆红素水平、谷丙转氨酶(ALT)、碱性磷酸酶(ALP)均显著下降,与对照组比较差异有统计学意义(P<0.05)。观察组ERCP术后一周内3例患者合并胆管炎,2例合并高淀粉酶血症;对照组分别有2例合并胆管炎,2例合并轻症胰腺炎,两组间差异无统计学意义(P>0.05)。观察组ERCP术后3月后2例患者发现支架阻塞,对照组8例支架阻塞(P<0.05)。结论:胆管引流术是治疗肝移植术后胆管狭窄的安全、有效手段。联合应用UDCA,可进一步加强胆汁排泌,抑制胆管免疫反应,保护肝细胞;并有效降低了后期支架阻塞率,预防了吻合口再狭窄。

    关键词肝移植胆管狭窄,胆管引流术,熊去氧胆酸

     

     

    The treatment of biliary stricture after liver transplantation by biliary drainage with ursodeoxycholic acid

    Zhu FengWan XinjianLu Lungenet a1

    Department of Gastroenterology, Shanghai First Peoples Hospital, Shanghai Jiaotong University, Shanghai 200080, PR China

    [Abstract] Objective: To evaluate the effect of combination treatment on biliary stricture after liver transplantation by biliary drainage with ursodeoxycholic acid (UDCA)

    Materials and Methods: Biliary drainage during endoscopic retrograde cholangiography (ERC) was performed in 35 patients (21 cases with primary liver cancer, 11 cases with liver cirrhosis and 3 cases with primary biliary cirrhosis) with biliary stricture after liver transplantation. All the patients who were given hepatoprotectionsupport therapy and anti-inflammation therapy were randomly divided into two groups18 cases in the observing group were given UDCA 10 mgkg 15 mgkg a day in the meantime about one month. Results: Six patients were successfully performed with nasobiliary drainage and 29 patients with plastic stand drainage (17 with single stand and 12 with double plastic stands)The serum bilirubin , ALT, ALP were decreased after ERCP, especially in the observing group in 14 days and 30 days after ERCP (P<0.05)Within one week after ERCP, 5 cases in the observing group had complications (3 with cholangitis and 2 with hyperamylasemia) while 4 cases in the control group had complications (2 with cholangitis and 2 with mild pancreatitis P>0.05). Three months after ERCP, 2 cases in the observing group and 8 cases in the control group had stand obstruction (P<0.05). Conclusion: Biliary drainage during ERC is a safe and effective method of treating biliary stricture after liver transplantationand combination with UDCA can reinforce the therapy result by decreasing serum bilirubinsuppressing the immunereaction of bile ductprotecting the hepatocyte and reducing the occlusion rate of stand

    [Key words] biliary strictureliver transplantation , biliary drainage , ursodeoxycholic acid

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