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【文摘发布】肝移植后非吻合性胆道狭窄的处理
Author:Verdonk RC, Buis CI, van der Jagt EJ, Gouw AS, Limburg AJ, Slooff MJ, Kleibeuker JH, Porte RJ, Haagsma EB
Source:Liver Transpl. 2007 Apr 24;13(5):725-732
IF:4.447(2005)
Nonanastomotic biliary strictures (NAS) after orthotopic liver transplantation (OLT) are associated with high retransplant rates. The aim of the present study was to describe the treatment of and identify risk factors for radiological progression of bile duct abnormalities, recurrent cholangitis, biliary cirrhosis, and retransplantation in patients with NAS. We retrospectively studied 81 cases of NAS. Strictures were classified according to severity and location. Management of strictures was recorded. Possible prognostic factors for bacterial cholangitis, radiological progression of strictures, development of severe fibrosis/cirrhosis, graft survival, and patient survival were evaluated. Median follow-up after OLT was 7.9 years. NAS were most prevalent in the extrahepatic bile duct. Twenty-eight patients (35%) underwent some kind of interventional treatment, leading to a marked improvement in biochemistry. Progression of disease was noted in 68% of cases with radiological follow-up. Radiological progression was more prevalent in patients with early NAS and one or more episodes of bacterial cholangitis. Recurrent bacterial cholangitis (>3 episodes) was more prevalent in patients with a hepaticojejunostomy. Severe fibrosis or cirrhosis developed in 23 cases, especially in cases with biliary abnormalities in the periphery of the liver. Graft survival, but not patient survival, was influenced by the presence of NAS. Thirteen patients (16%) were retransplanted for NAS. In conclusion, especially patients with a hepaticojejunostomy, those with an early diagnosis of NAS, and those with NAS presenting at the level of the peripheral branches of the biliary tree, are at risk for progressive disease with severe outcome. 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领 Title:Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression.
题目：肝移植后非吻合性胆道狭窄的处理、结果和预后因子
肝Author:Verdonk RC, Buis CI, van der Jagt EJ, Gouw AS, Limburg AJ, Slooff MJ, Kleibeuker JH, Porte RJ, Haagsma EB
Source:Liver Transpl. 2007 Apr 24;13(5):725-732
IF:4.447(2005)
Nonanastomotic biliary strictures (NAS) after orthotopic liver transplantation (OLT) are associated with high retransplant rates. The aim of the present study was to describe the treatment of and identify risk factors for radiological progression of bile duct abnormalities, recurrent cholangitis, biliary cirrhosis, and retransplantation in patients with NAS.
背景：原位肝移植术后非吻合性胆道狭窄(NAS)常伴随着高的再次移植率。本研究目的是调查NAS发生复发性胆管炎、胆汁性肝硬化和再次移植患者的处理结果并辨别影像学胆道异常进行性发展的危险因子。
We retrospectively studied 81 cases of NAS. Strictures were classified according to severity and location. Management of strictures was recorded. Possible prognostic factors for bacterial cholangitis, radiological progression of strictures, development of severe fibrosis/cirrhosis, graft survival, and patient survival were evaluated. Median follow-up after OLT was 7.9 years.
方法：我们回顾性研究81例NAS患者。狭窄根据程度和所在部位加以分类，并记录针对狭窄的治疗结果。评估肝移植后细菌性胆管炎、影像学胆道进行性狭窄、发生严重肝纤维化/肝硬化、移植肝存活和存活患者的可能预后因素。肝移植后中位随访时间为7.9年。
NAS were most prevalent in the extrahepatic bile duct. Twenty-eight patients (35%) underwent some kind of interventional treatment, leading to a marked improvement in biochemistry. Progression of disease was noted in 68% of cases with radiological follow-up. Radiological progression was more prevalent in patients with early NAS and one or more episodes of bacterial cholangitis. Recurrent bacterial cholangitis (>3 episodes) was more prevalent in patients with a hepaticojejunostomy. Severe fibrosis or cirrhosis developed in 23 cases, especially in cases with biliary abnormalities in the periphery of the liver. Graft survival, but not patient survival, was influenced by the presence of NAS. Thirteen patients (16%) were retransplanted for NAS.
结果：NAS常发生在肝外胆管。28例给予介入治疗，生化指标明显改善。影像学随访68％患者进行性狭窄。影像学NAS进行性狭窄常发生在早期NAS患者和单发及多发性细菌性胆管炎患者。行肝十二指肠吻合术患者常发生多发性细菌性胆管炎（>3次）。23例患者发生肝纤维化或肝硬化，在肝周围胆管异常患者中表现突出。NAS对移植肝存活有影响，而对患者存活无影响。13 例患者由于NAS再次肝移植。
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作者:admin@医学,生命科学 2010-10-09 05:11
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