原位肝脏移植术后胆瘘的类型与治疗

Objective To discuss the type, treatment and results of different therapies of biliary fistula after orthotopic liver tansplantation (OLT). Methods Data of 24 patients who developed biliary fistula after OLT in the First Affiliated Hospital of Xi' an Jiaotong University from January 2000 to March 2019 were retrospectively analyzed. Patients with biliary fistula were classified into 4 types according to presence or absence of stricture. All patients were treated by endoscopic retrograde cholangiopancreatography (ERCP) or interventional therapy, including endoscopic nasobiliary drainage (ENBD), endoscopic retrograde biliary drainage (ERBD) or percuteneous transhepatic cholangial drainage (PTCD). Main outcome measurements were the onset time of biliary fistula, the site of biliary fistula, the complications of ERCP or PTCD, the time of removing abdominal or biliary drainage tube, and the onset of new biliary stricture. Results Biliary fistula was found in (46. 5±36. 6) days (6-122 days) after OLT. The numbers of patients in four types of biliary fistula were 6, 14, 2 and 2, respectively. Biliary fistula was cured in 22 patients, with clinical cure rate of 91. 7%. All patients underwent ERCP first, and the technical success rate and clinical cure rate were 87. 5% (21/24) and 85. 7% (18/21), respectively. The clinical cure rates of ERCP forⅠ-Ⅳ biliary fistula were 6/6, 84. 6%(11/13), 1/2, and 0, respectively. The clinical cure rates of ENBD and ERBD were 8/10 and 6/8, respectively. Five cases in whom ERCP failed, underwent PTCD, with technical success and clinical cure rates of 4/5 and 3/4 respectively. Eight patients(33. 3%)developed cholangitis after treatment, and the incidence rate seemed higher in type Ⅱ biliary fistula than that in type Ⅰ [35. 7% (5/14) VS 16. 7% (1/6)]. Incidence of cholangitis was higher in patients with non-anastomotic stricture than those with anastomotic stricture [83. 3% (5/6) VS 16. 7% (3/18)]. Conclusion The first line treatment for biliary fistula after OLT is ERCP, followed by PTCD. The best procedures of biliary fistula type Ⅰ-Ⅳ were ENBD, ENBD combined with ERBD, ENBD and PTCD, respectively.