Abstract:

Objective To discuss the efficacy of endoscopic retrograde cholangiography （ERC）in the diagnosis and management of bile leakage after orthotopic liver transplantation（OLT）. Methods FromJanuary 2005 to February 2013，23 patients with bile leakage after OLT who were diagnosed by means of magnetic resonance cholangiopancreatography（MRCP）or ERC. The clinical data of 23 cases with bile leakage were reviewedretrospectively，including postoperation time，the location of the bile leakage，times of ERC and whether need bilary stenting，then the clinical value of ERC was evaluated. Results We carried out a retrospective review of 23 consecutive patients with bile leakage after OLT（Male 19，Female 4），the mean age was（49.0±5.8）years old，and one case failed because unsuccessful bile duct cannulation ；Therapeutic procedures were carried out in 22 patients， which included endoscopic nasobiliary drainage（ENBD）or endoscopic retrograde biliary drainage（ERBD），cilincal success in 18 patients（three combined with peritoneal drainage，four combined with T-tube fistula drainage）， and one drainaged by percutaneous transhepatic drainage（PTCD），three received re-operation，one died because of serious hematosepsis. Conclusions ERC is an effective method for diagnosis of post-OLT bile leakage，its sensitivity and diagnostic accuracy is higher than MRCP and its theraputic effection for different types of bile leakage after OLT is cure. However，the therapeutic effect of ERC was relatively poor for some patients who suffered severesecondary bacterial infection，and whose medical prognosis gets grim.

Key words:

Orthotopic liver transplantation ； Bile leakage ； Biliary complication ； Endoscopic retrograde cholangiography ； ,

Endoscopic nasobiliary drainage ； Endoscopic retrograde biliary drainage ； Magnetic resonance cholangiopancreatography ,

摘要：

目的 探讨经内镜逆行胆管造影术（ERC）在原位肝移植术（OLT）后胆漏中的诊疗作用。 方法 回顾分析 ERC 在 23 例 OLT 术后胆漏中的诊疗作用，包括胆漏发生时间、胆漏部位、接受 ERC 诊断治疗过程、治疗效果等临床资料，并评价其诊疗价值。结果 本研究共纳入 OLT 术后胆漏患者 23 例，其中男性 19 例，女性 4 例，平均（49.0±5.8）岁。术前磁共振胰胆管成像术（MRCP）诊断胆漏 14 例，术中ERC 证实胆漏 22 例均行经内镜鼻胆管引流术（ENBD）和（或）经内镜胆道内支架置入术（ERBD）治疗，18 例经内镜治疗好转（其中 3 例联合腹腔引流，4 例联合引流管经 T 管窦道引流），1 例行经皮肝穿胆管引流术（PTCD）；3 例再次手术，1 例因严重感染死亡。结论 ERC 是诊断 OLT 术后胆漏的有效手段，其敏感性高于 MRCP，ERC 介入治疗是 OLT 术后不同类型胆漏的有效治疗手段，但对于存在继发严重感染者预后较差。

关键词:

"> 原位肝移植术 ； 胆漏 ； 胆道并发症 ； 经内镜逆行胆管造影术 ； 经内镜鼻胆管引流术 ； 经内镜胆道内支架置入术 ；

"> 磁共振胰胆管成像术