切换至 "中华医学电子期刊资源库"

中华移植杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 232 -238. doi: 10.3877/cma.j.issn.1674-3903.2021.04.010

综述

肝移植术后胆道并发症研究进展
陈非凡1, 赵红川1,()   
  1. 1. 230022 合肥,安徽医科大学第一附属医院器官移植中心
  • 收稿日期:2021-04-01 出版日期:2021-08-25
  • 通信作者: 赵红川
  • 基金资助:
    国家自然科学基金项目(81702829)

Progress in biliary complications after liver transplantation

Feifan Chen1, Hongchuan Zhao1,()   

  1. 1. Department of Organ Transplantation, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
  • Received:2021-04-01 Published:2021-08-25
  • Corresponding author: Hongchuan Zhao
引用本文:

陈非凡, 赵红川. 肝移植术后胆道并发症研究进展[J]. 中华移植杂志(电子版), 2021, 15(04): 232-238.

Feifan Chen, Hongchuan Zhao. Progress in biliary complications after liver transplantation[J]. Chinese Journal of Transplantation(Electronic Edition), 2021, 15(04): 232-238.

肝移植术后胆道并发症(BC)一般指肝移植术后胆道异常导致肝功能恢复异常或胆汁代谢异常情况的统称。近年来,随着内镜技术的不断发展,内窥镜治疗已成为肝移植术后BC的主要治疗方式。BC是评估肝移植术后疗效的重要指标,与术前供肝保存、术中手术操作和术后免疫排斥反应等诸多因素密切相关。本文对近年来肝移植术后BC分类、机制、诊断、预防及治疗进行综述。

Biliary complications (BC) after liver transplantation generally refer to the general term of abnormal recovery of liver function or abnormal bile metabolism caused by abnormal biliary tract after liver transplantation. In recent years, with the continuous development of endoscopic technology, endoscopic therapy has become the mainstream modality for the treatment of biliary complications after liver transplantation. Biliary complications are important indicators for evaluating the efficacy after liver transplantation, and many factors such as donor liver preservation, intraoperative surgical operation and postoperative immune rejection are closely related. In this paper, the classification, mechanism, diagnosis, prevention and treatment of BC after liver transplantation are discussed.

1
Carmelino J, Rodrigues S, Marques HP, et al. Biliary anastomosis in liver transplantation: with or without T-tube?[J]. Acta Med Port, 2017, 30(2): 122-126.
2
Shamsaeefar A, Nikeghbalian S, Kazemi K, et al. Thirteen-year evaluation of the management of biliary tract complication after deceased donor liver transplantation[J]. Prog Transplant, 2017, 27(2): 192-195.
3
Akamatsu N, Sugawara Y, Hashimoto D. Biliary reconstruction, itscomplications and management of biliary complications after adult liver transplantation: a systematic review of the incidence, risk factors and outcome[J]. Transpl Int, 2011, 24(4): 379-392.
4
Jagannath S, Kalloo AN. Biliary complications after liver transplantation[J]. Curr Treat Options Gastroenterol, 2002, 5(2): 101-112.
5
Verdonk RC, Buis CI, Porte RJ, et al. Anastomotic biliary strictures after liver transplantation: causes and consequences[J]. Liver Transpl, 2006, 12(5): 726-735.
6
Bourgeois N, Deviere J, Yeaton P, et al.Diagnostic and therapeutic endoscopic retrograde cholangiography after liver transplantation[J]. Gastrointest Endosc, 1995, 42(6): 527-534.
7
Macías-Gómez C, Dumonceau JM. Endoscopic management of biliary complications after liver transplantation: An evidence-based review[J]. World J Gastrointest Endosc, 2015, 7(6): 606-616.
8
Jay CL, Lyuksemburg V, Ladner DP, et al. Ischemic cholangiopathy after controlled donation after cardiac death liver transplantation: a meta-analysis[J]. Ann Surg, 2011, 253(2): 259-264.
9
Op den Dries S, Sutton ME, Lisman T, et al. Protection of bile ducts in liver transplantation: looking beyond ischemia[J]. Transplantation, 2011, 92(4): 373-379.
10
Sharma S, Gurakar A, Jabbour N. Biliary strictures following liver transplantation: past, present and preventive strategies[J]. Liver Transpl, 2008, 14(6): 759-769.
11
Buis CI, Verdonk RC, Van der Jagt EJ, et al. Nonanastomotic biliary strictures after liver transplantation, part 1: radiological features and risk factors for early vs. late presentation[J]. Liver Transpl, 2007, 13(5): 708-718.
12
Hansen T, Hollemann D, Pitton MB, et al. Histological examination and evaluation of donor bile ducts received during orthotopic liver transplantationea morphological clue to ischemic-type biliary lesion?[J]. Virchows Arch, 2012, 461(1): 41-48.
13
Brunner SM, Junger H, Ruemmele P, et al. Bile duct damage after cold storage of deceased donor livers predicts biliary complications after liver transplantation[J]. J Hepatol, 2013, 58(6): 1133-1139.
14
Karimian N, Op den Dries S, Porte RJ. The origin of biliary strictures after liver transplantation: is it the amount of epithelial injury or insufficient regeneration that counts?[J]. J Hepatol, 2013, 58(6): 1065-1067.
15
op den Dries S, Westerkamp AC, Karimian N, et al. Injury to peribiliary glands and vascular plexus before liver transplantation predicts formation of non-anastomotic biliary strictures[J]. J Hepatol, 2014, 60(6): 1172-1179.
16
Cardinale V, Wang Y, Carpino G, et al. Multipotentstem/progenitor cells in human biliary tree give rise to hepatocytes, cholangiocytes, and pancreatic islets[J]. Hepatology, 2011, 54(6): 2159-2172.
17
Sutton ME, op den Dries S, Koster MH, et al. Regeneration of human extrahepatic biliary epithelium: the peribiliary glands as progenitor cell compartment[J]. Liver Int , 2012, 32(4): 554-559.
18
Dipaola F, Shivakumar P, Pfister J, et al. Identification of intramural epithelial networks linked to peribiliary glands that express progenitor cell markers and proliferate after injury in mice[J]. Hepatology, 2013, 58(4): 1486-1496.
19
Londoño MC, Balderramo D, Cárdenas A. Management of biliary complications after orthotopic liver transplantation: the role of endoscopy[J]. World J Gastroenterol, 2008, 14(4): 493-497.
20
Faleschini G, Vadalà di Prampero SF, Bulajic M, et al. Predictors of endoscopic treatment outcome in the management of biliary complications after orthotopic liver transplantation[J]. Eur J Gastroenterol Hepatol, 2015, 27(2): 150-154.
21
Verdonk RC, Buis CI, Porte RJ, et al. Biliary complications after liver transplantation: a review[J]. Scand J Gastroenterol Suppl, 2006, 243: 89-101.
22
Wojcicki M, Milkiewicz P, Silva M. Biliary tract complications after liver transplantation: a review[J]. Dig Surg, 2008, 25(4): 245-257.
23
Li T, Chen ZS, Zeng FJ, et al. Impact of early biliary complications in liver transplantation in the presence or absence of a T-tube: a Chinese transplant centre experience[J]. Postgrad Med J, 2007, 83(976): 120-123.
24
Park TY, Lee SK, Nam K, et al. Spontaneous hemobilia after liver transplantation: Frequency, risk factors, and outcome of endoscopic management[J]. J Gastroenterol Hepatol, 2017, 32(3): 583-588.
25
Koneru B, Zajko AB, Sher L, et al. Obstructing mucocele of the cystic duct after transplantation of the liver[J]. Surg Gynecol Obstet, 1989, 168(5): 394-396.
26
Kitazono MT, Qayyum A, Yeh BM, et al. Magnetic resonance cholangiography of biliary strictures after liver transplantation: a prospective double-blind study[J]. J Magnetic Reson imaging, 2007, 25(6): 1168-1173.
27
Seale MK, Catalano OA, Saini S, et al. Hepatobiliary-specific M R contrast agents: role in imaging the liver and biliary tree[J]. Radiographics, 2009, 29(6): 1725-1748.
28
Yeh BM, Liu PS, Soto JA, et al. MR imaging and CT of the biliary tract[J]. Radiographics, 2009, 29(6): 1669-1688.
29
Boraschi P, Braccini G, Gigoni R, et al. Detection of biliary complications after orthotopic liver transplantation with MR cholangiography[J]. Magn Reson Imaging, 2001, 19(8): 1097-1105.
30
Boraschi P, Donati F, Gigoni R, et al. MR cholangiography in orthotopic liver transplantation: sensitivity and specificity in detecting biliary complications[J]. Clin Transplant, 2010, 24(4): E82-E87.
31
Thethy S, Thomson B, Pleass H, et al.Management of biliary tract complications after orthotopic liver trans-plantation[J]. Clin Transplant, 2004, 18(6): 647-653.
32
Morelli J, Mulcahy HE, Willner IR, et al. Long-term outcomes for patients with post-liver transplant anastomotic biliary strictures treated by endoscopic stent placement[J]. Gastrointest Endosc, 2003, 58(3): 374-37933
33
Mahajani RV, Cotler SJ, Uzer MF. Efficacy of endoscopic management of anastomotic biliary strictures after hepatic transplantation[J]. Endoscopy, 2000, 32(12): 943-949.
34
Gastaca M. Biliary complications after orthotopic liver transplantation: a review of incidence and risk factors[J]. Transplant Proc, 2012, 44(6): 1545-1549.
35
Bae C, Henry SD, Guarrera JV. Is extracorporeal hypothermic machine perfusion of the liver better than the 'good old icebox' ?[J]. Curr Opin Organ Transplant, 2012, 17(2): 137-142.
36
Vekemans K, van Pelt J, Komuta M, et al. Attempt to rescue discarded human liver grafts by end ischemic hypothermic oxygenated machine perfusion[J]. Transplant Proc. 2011;43(9): 3455-3459.
37
邝伟键,谭晓宇,何锡然,刘华敏,张琳,郭家钘,陈素平,霍枫.离体肝脏双泵双氧合机械灌注设备应用于猪肝脏常温机械灌注的可行性研究[J].医疗卫生装备2021, 42(05): 1-5+20.
38
杨柳,曹欢,孙东,侯宾,林玲,宋红丽.常温机械灌注对大鼠心脏死亡器官捐献供肝微循环保护作用的研究[J].实用器官移植电子杂志2021, 9(02): 120-125.
39
Taylor MJ, Baicu SC. Current state of hypothermic machine perfusion preservation of organs:the clinical perspective[J]. Cryobiology, 2010, 60(Suppl 3): S20-S35.
40
Wang B, Zhang Q, Zhu B, et al. Protective effect of gadolinium chloride on early warm ischemia/reperfusion injury in rat bile duct during liver transplantation[J]. PLoS One, 2013, 8(1): e52743.
41
武帅,赵浩亮,韩振国,等.自制含氟碳液在机器灌注保存供肝中的应用[J].山西医科大学学报2008, 39(5): 463-465.
42
van Raemdonck D, Neyrinck A, Rega F, et al. Machine perfusion in organ transplantation: a tool for ex-vivo graft conditioning with mesenchymal stem cells?[J]. Curr Opin Organ Transplant, 2013, 18(1): 24-33.
43
Popp F, Fillenberg B, Eggenhofer E, et al. Safety and feasibility of third-party multipotent adult progenitor cells for immunomodulation therapy after liver transplantation - A phase I study (MISOT-I) [J]. J Transl Med, 2011, 9: 124-124.
44
Franquesa M, Hoogduijn M, Reinders M, et al. Mesenchymal Stem Cells in Solid Organ Transplantation (MiSOT) Fourth Meeting: lessons learned from first clinical trials[J]. Transplantation, 2013, 96(3): 234-238.
45
Hindley CJ, Cordero-Espinoza L, Huch M. Organoids from adult liver and pancreas: Stem cell biology and biomedical utility[J]. Dev Biol, 2016, 420(2): 251-261.
46
Shaked A. Use of T tube in liver transplantation[J]. Liver Transpl Surg, 1997, 3(5 Suppl 1): S22-S23.
47
Weiss S, Schmidt SC, Ulrich F, et al. Biliary reconstruction using a side-to-side choledochocholedochostomy with or without T-tube in deceased donor liver transplantation: a prospective randomized trial[J]. Ann Surg, 2009, 250(5): 766-771.
48
Sotiropoulos GC, Sgourakis G, Radtke A, et al. Orthotopic liver transplantation: T-tube or not T-tube? Systematic review and meta-analysis of results[J]. Transplantation, 2009, 87(11): 1672-1680.
49
Sun N, Zhang J, Li X, et al. Biliary tract reconstruction with or without T-tube in orthotopic liver transplantation: a systematic review and meta-analysis[J]. Expert Rev Gastroenterol Hepatol, 2015, 9(4): 529-538.
50
López-Andújar R, Orón EM, Carregnato AF, et al. T-tube or no T-tube in cadaveric orthotopic liver transplantation: the eternal dilemma: results of a prospective and randomized clinical trial [J]. Ann Surg. 2013;258(1): 21-29.
51
Song S, Lu T, Yang W, et al. T-tube or no T-tube for biliary tract reconstruction in orthotopic liver transplantation: an updated systematic review and meta-analysis [J] [published online ahead of print, 2021 Apr 7]. Expert Rev Gastroenterol Hepatol. 2021;1-12.
52
Northover JM, Terblanche J. A new look at the arterial supply of the bile duct in man and its surgical implications[J]. Br J Surg, 1979, 66(6) : 379-384.
53
梁宾勇,王少发,陈知水,等. 新的保护胆道血供的修肝方法对肝移植术后胆道并发症的影响[J].临床外科杂志2017, 25(8): 611-614.
54
Zoepf T, Maldonado-Lopez EJ, Hilgard P, et al. Balloon dilatation vs. balloon dilatation plus bile duct endoprostheses for treatment of anastomotic biliary strictures after liver transplantation[J]. Liver Transpl, 2006, 12(1): 88-94.
55
Alazmi WM, Fogel EL, Watkins JL, et al. Recurrence rate of anastomotic biliary strictures in patients who have had previous successful endoscopic therapy for anastomotic narrowing after orthotopic liver transplantation[J]. Endoscopy, 2006, 38(6): 571-574.
56
Kao D, Zepeda-Gomez S, T andon P, et al. Managing the post-liver transplantation anastomotic biliary stricture: multiple plastic versus metal stents: a systematic review[J]. Gastrointest Endosc, 2013, 77(5): 679-691.
57
Holt AP, Thorburn D, Mirza D, et al. A prospective study of standardized nonsurgical therapy in the management of biliary anastomotic strictures complicating liver transplantation[J]. Transplantation, 2007, 84(7): 857-863.
58
Girotra M, Soota K, Klair JS, et al. Endoscopic management of post-liver transplant biliary complications[J]. World J Gastrointest Endosc, 2015, 7(5): 446-459.
59
Hsieh TH, Mekeel KL, Crowell MD, et al. Endoscopic treatment of anastomotic biliary strictures after living donor liver transplantation: outcomes after maximal stent therapy[J]. Gastrointest Endosc, 2013, 77(1): 47-54.
60
Coté GA, Slivka A, Tarnasky P, et al. Effect of covered metallic stents compared with plastic stents on benign biliary stricture resolution: A randomized clinical trial[J]. JAMA, 2016, 315(12): 1250-1257.
61
Chaput U, Scatton O, Bichard P, et al.Temporary placement of partially covered self-expandable metal stents for anastomotic biliary strictures after liver transplantation: a prospective multicenter study[J]. Gastrointest Endosc, 2010, 72(6): 1167-1174.
62
Wang AY, Sauer BG, Behm BW, et al. Singleballoon enteroscopy effectively enables diagnostic and therapeutic retrograde cholangiography in patients with surgically altered anatomy[J]. Gastrointest Endosc, 2010, 71(3): 641-649.
63
Chahal P, Baron TH, Poterucha JJ, et al. Endoscopic retrograde cholangiography in post-orthotopic liver transplant population with Roux-en-Y biliary reconstruction[J]. Liver Transpl, 2007, 13(8): 1168-1173.
64
Parlak E, Cicek B, Disibeyaz S, et al. Endoscopic retrograde cholangiography by double balloon enteroscopy in patients with Roux-en-Y hepaticojejunostomy[J]. Surg Endosc, 2010, 24(2): 466-470.
65
Hüsing A, Reinecke H, Cicinnati VR, et al. Paclitaxel-eluting balloon dilation of biliary anastomotic stricture after liver transplantation[J]. World J Gastroenterol, 2015, 21(3): 977-981.
66
李宇,田敏,严小鹏,等.关于利用磁力再通术治疗肝移植术后胆道吻合口狭窄的专家建议[J].器官移植2020, 11(1): 13-18.
67
Li Y, Sun H, Yan X, et al. Magnetic compression anastomosis for the treatment of benign biliary strictures: a clinical study from China[J]. Surg Endosc, 2020, 34(6): 2541-2550.
68
Graziadei IW, Schwaighofer H, Koch R, et al. Long-term outcome of endoscopic treatment of biliary strictures after liver transplantation[J]. Liver Transpl, 2006, 12(5): 718-725.
69
Verdonk RC, Buis CI, van der Jagt EJ, et al. Nonanastomotic biliary strictures after liver transplantation, part 2: management, outcome, and risk factors for disease progression[J]. Liver Transpl, 2007, 13(5): 725-732.
70
Buis CI, Hoekstra H, Verdonk RC, et al. Causes and consequences of ischemic-type biliary lesions after liver transplantation[J]. J Hepatobiliary Pancreat Surg, 2006, 13(6): 517-524.
71
Hampe T, Dogan A, Encke J, et al. Biliary complications after liver transplantation[J]. Clin Transplant, 2006, 20(Suppl 17): 93-96.
72
Guichelaar MM, Benson JT, Malinchoc M, et al. Risk factors for and clinical course of non-anastomotic biliary strictures after liver transplantation[J]. Am J Transpl, 2003, 3(7): 885-890.
73
Thuluvath PJ, Pfau PR, Kimmey MB, et al. Biliary complications after liver transplantation: the role of endoscopy[J]. Endoscopy, 2005, 37(9): 857-863.
74
Tsujino T, Isayama H, Sugawara Y, et al. Endoscopic management of biliary complications after adult living donor liver transplantation[J]. Am J Gastroenterol, 2006, 101(10): 2230-2236.
75
Luigiano C, Bassi M, Ferrara F, et al. Placement of a new fully covered self-expanding metal stent for postoperative biliary strictures and leaks not responding to plastic stenting[J]. Surg Laparosc Endosc Percutan Tech, 2013, 23(2): 159-162.
[1] 张红霞, 程令刚, 汪洪斌, 张巍, 张雨康, 何文. 巨大肝囊肿无水乙醇硬化治疗后胆道损伤探讨[J]. 中华医学超声杂志(电子版), 2023, 20(05): 487-491.
[2] 李坤河, 寇萌佳, 邝立挺. 肝移植术后二次气管插管的危险因素及预测模型的建立[J]. 中华普通外科学文献(电子版), 2023, 17(05): 366-371.
[3] 中华医学会器官移植学分会, 中国医师协会器官移植医师分会, 上海医药行业协会. 中国肝、肾移植受者霉酚酸类药物应用专家共识(2023版)[J]. 中华移植杂志(电子版), 2023, 17(05): 257-272.
[4] 陆闻青, 陈昕怡, 任雪飞. 遗传代谢病儿童肝移植受者术后生活质量调查研究[J]. 中华移植杂志(电子版), 2023, 17(05): 287-292.
[5] 范铁艳, 李君, 陈虹. 肝移植术后新发戊型病毒性肝炎的诊治经验[J]. 中华移植杂志(电子版), 2023, 17(05): 293-296.
[6] 陈朔, 陈峰, 程飞, 项捷. 糖原累积病Ⅰ型并发胰腺炎肝移植术后胰腺梗死一例[J]. 中华移植杂志(电子版), 2023, 17(05): 300-302.
[7] 汤鹏昊, 张武. 肠道微生态与肝移植围手术期并发症相关研究进展[J]. 中华移植杂志(电子版), 2023, 17(05): 303-307.
[8] 中国器官移植发展基金会器官移植受者健康管理专家委员会, 中国医师协会器官移植医师分会, 中华医学会器官移植学分会, 国家肝脏移植质控中心. 肝移植受者雷帕霉素靶蛋白抑制剂临床应用中国专家共识(2023版)[J]. 中华移植杂志(电子版), 2023, 17(04): 193-204.
[9] 严庆, 刘颖, 邓斐文, 陈焕伟. 微血管侵犯对肝癌肝移植患者生存预后的影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 624-629.
[10] 廖梅, 张红君, 金洁玚, 吕艳, 任杰. 床旁超声造影对肝移植术后早期肝动脉血栓的诊断价值[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 630-634.
[11] 李秉林, 吕少诚, 潘飞, 姜涛, 樊华, 寇建涛, 贺强, 郎韧. 供肝灌注液病原菌与肝移植术后早期感染的相关性分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 656-660.
[12] 吕垒, 冯啸, 何凯明, 曾凯宁, 杨卿, 吕海金, 易慧敏, 易述红, 杨扬, 傅斌生. 改良金氏评分在儿童肝豆状核变性急性肝衰竭肝移植手术时机评估中价值并文献复习[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 661-668.
[13] 王孟龙. 肿瘤生物学特征在肝癌肝移植治疗中的意义[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 490-494.
[14] 杨海龙, 邓满军, 樊羿辰, 徐梦钰, 陈芳德, 吴威浩, 张生元. 腹腔镜胆总管探查术一期缝合术后胆漏危险因素Meta分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 545-550.
[15] 周标, 陈达伟, 汤晓东, 陈胜, 刘双海, 邓志成. 腹腔镜下经胆囊管汇入部微切开取石在细径胆总管结石合并胆囊结石中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(04): 422-426.
阅读次数
全文


摘要