原位肝移植术后胆道结石的临床研究

目的 探讨原位肝移值术后胆道结石的诊治。方法 回顾性分析2000年1月至2003年1月完成的206例原位肝移值的临床资料，总结术后胆道结石的防治经验。结果11例病人术后并发胆道结石，发病率为5．3%。表现为颗粒样结石和胆泥两种形式。发生部位在胆总管者7例，在肝内胆道者1例。胆泥和颗粒样结石的首次诊断时间分别平均为138d和306d。胆道感染是胆道结石发作的主要症状。11例病例中有7例合并不同程度的胆道狭窄。主要依靠经“T”管照影或FRL、P(endoscopic reirograde cholangiopancreatography)术明确诊断。FRCP术是主要的非手术治疗手段，7例胆总管结石经1～3次ERCP术后痊愈。4例肝内胆道结石中合并弥漫性胆道狭窄者有3例，其中2例行再次肝移植术。结论 胆道狭窄是肝移植术后胆道结石的主要原因，胆道黏膜的缺血坏死合并胆道感染是胆泥形成的主要机制。ERCP术对胆总管绵石有良好疗效，对合并弥漫性胆道狭窄的肝内胆道结石病人肝脏再移值往往不可避免。

Clinical study on biliary stones and sludge following orthotopic liver transplantation

Objective To explore the prevention and appropriate management of biliary stones and sludge following orthotopic liver transplantation (OLT). Methods The clinical data of 206 patients receiving OLT in our center between January 2001 and January 2003 were retrospectively analyzed. Results After the transplantation, the occurring rate of biliary stones and sludge was 5.3% (11/206). T-tube cholangiography and ERCP showed that the biliary stones and sludge were located in the intrahepatic bile duct in 4 patients and in the common bile duct in 7. The average interval between transplantation and diagnosis was 138 d for patients with biliary sludge and 306 d for those with biliary stones. The major clinical presentation was cholangitis. Seven patients had biliary stricture. The stones in the common bile duct were removed in 7 cases by ERCP for 1-3 times. Three patients with intrahepatic sludge had multiple intrahepatic biliary stricture and 2 of them received Retransplantation. Conclusions Biliary stricture is the main cause of biliary stones and sludge following OLT. The primary mechanism of biliary sludge is ischemic necrosis of the mucosa and duct wall due to infection. ERCP is an effective means to cure common bile duct stones. However, the liver retransplantation is an inevitable choice for the patients with biliary sludge plus multiple intrahepatic biliary stricture.