留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

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

中华医学会外科学分会外科手术学学组

中华医学会外科学分会外科手术学学组. 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. doi: 10.3969/j.issn.1674-7445.2020.01.003
引用本文: 中华医学会外科学分会外科手术学学组. 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. doi: 10.3969/j.issn.1674-7445.2020.01.003
Operative Surgery Group of Branch of Surgery of Chinese Medical Association. Expert recommendation on magnetic recanalization for the treatment of biliary anastomosis stricture after liver transplantation[J]. ORGAN TRANSPLANTATION, 2020, 11(1): 13-18. doi: 10.3969/j.issn.1674-7445.2020.01.003
Citation: Operative Surgery Group of Branch of Surgery of Chinese Medical Association. Expert recommendation on magnetic recanalization for the treatment of biliary anastomosis stricture after liver transplantation[J]. ORGAN TRANSPLANTATION, 2020, 11(1): 13-18. doi: 10.3969/j.issn.1674-7445.2020.01.003

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

doi: 10.3969/j.issn.1674-7445.2020.01.003
基金项目: 

国家自然科学基金面上项目 81470896

陕西省科技资源开放共享平摊项目 2016FWPT-01

详细信息
    通讯作者:

    李宇,男,1982年生,医学博士,主治医师,研究方向为肝移植、微创外科及ERCP,Email:liyu-820219@163.com
    吕毅,男,1963年生,医学博士,主任医师,研究方向为原发性肝癌以手术为主的综合治疗、终末期肝病肝移植、磁力吻合技术及新型材料在外科应用、组织工程与再生医学研究及应用,Email:liyu-820219@163.com

  • 中图分类号: R617, P716+.82

Expert recommendation on magnetic recanalization for the treatment of biliary anastomosis stricture after liver transplantation

More Information
  • 摘要: 胆道吻合口狭窄是肝移植术后的常见并发症之一。目前内镜下逆行性胰胆管造影术(ERCP)和经皮经肝胆道引流术(PTCD)为首选治疗。对于严重吻合口狭窄或闭塞的病例,常规方法难以完成后继的治疗,磁力再通技术为治疗此类病例提供了另一种选择。本文在系统回顾国内外文献的基础上,结合专家经验,在适应证和禁忌证、磁体的选择与设计、操作步骤、注意事项及并发症防治等方面形成磁力再通术治疗肝移植术后胆道吻合口狭窄的专家建议。

     

  • 图  1  胆道狭窄磁力再通术适应证的胆道造影图片

    注:A图示完全胆道吻合口梗阻;B图示完全胆肠吻合口梗阻;C图示不完全胆道吻合口梗阻。

    Figure  1.  Cholangiography images of the indications of magnetic recanalization for biliary stricture

    图  2  轴向带孔磁体

    Figure  2.  Magnet with axial hole

    图  3  外套杯状金属壳的磁体(直径2~5 mm)

    Figure  3.  Magnets with cup-shaped metal shell (diameter 2~5 mm)

    图  4  磁力再通术治疗胆道吻合口完全闭塞的操作过程

    注:A图示经PTCD及ERCP造影示胆道截断;B图示沿PTCD窦道和经乳头置入磁体至狭窄上下端;C图示两磁体稳定吸引;D图示经PTCD造影可见造影剂进入远端胆管;E图示内镜下拔出磁体,再次造影示胆道通畅;F图示胆道内置入10 mm全覆膜金属支架。

    Figure  4.  Surgical procedure for the treatment of magnetic recanalization on complete biliary anastomotic occlusion

    图  5  磁力再通术治疗胆道吻合口严重狭窄的操作过程

    注:A图示经PTCD确认狭窄位置;B图示调整导丝通过狭窄至十二指肠乳头外,内镜下牵拉导丝至体外;C图示经皮置入子磁体至狭窄上方,经口或内镜下推入母磁体至狭窄下方;D图示完成磁压榨吻合;E图示再通后经内镜拔出磁体;F图示在胆道内置入多支塑料支架。

    Figure  5.  Surgical procedure for the treatment of magnetic recanalization on severe biliary anastomotic stenosis

  • [1] 董家鸿.胆道并发症:肝移植的"阿喀琉斯之踵"[J].中华普通外科杂志, 2005, 20(8):465-466. DOI: 10.3760/j.issn:1007-631X.2005.08.001.

    DONG JH. Biliary complications: Achilles' heel in liver transplantation [J]. Chin J Gen Surg, 2005, 20(8):465-466. DOI: 10.3760/j.issn:1007-631X.2005.08.001.
    [2] KOKSAL AS, EMINLER AT, PARLAK E, et al. Management of biliary anastomotic strictures after liver transplantation[J]. Transplant Rev (Orlando), 2017, 31(3):207-217. DOI: 10.1016/j.trre.2017.03.002.
    [3] GONDOLESI GE, VAROTTI G, FLORMAN SS, et al. Biliary complications in 96 consecutive right lobe living donor transplant recipients[J]. Transplantation, 2004, 77(12):1842-1848. doi: 10.1097/01.TP.0000123077.78702.0C
    [4] SOIN AS, KUMARAN V, RASTOGI AN, et al. Evolution of a reliable biliary reconstructive technique in 400 consecutive living donor liver transplants[J]. J Am Coll Surg, 2010, 211(1):24-32. DOI: 10.1016/j.jamcollsurg.2010.02.048.
    [5] SHARMA S, GURAKAR A, JABBOUR N. Biliary strictures following liver transplantation: past, present and preventive strategies[J]. Liver Transpl, 2008, 14(6):759-769. DOI: 10.1002/lt.21509.
    [6] YAZUMI S, YOSHIMOTO T, HISATSUNE H, et al. Endoscopic treatment of biliary complications after right-lobe living-donor liver transplantation with duct-to-duct biliary anastomosis[J]. J Hepatobiliary Pancreat Surg, 2006, 13(6):502-510. doi: 10.1007/s00534-005-1084-y
    [7] WANG SF, HUANG ZY, CHEN XP. Biliary complications after living donor liver transplantation[J]. Liver Transpl, 2011, 17(10):1127-1136. DOI: 10.1002/lt.22381.
    [8] SOEJIMA Y, TAKETOMI A, YOSHIZUMI T, et al. Biliary strictures in living donor liver transplantation: incidence, management, and technical evolution[J]. Liver Transpl, 2006, 12(6):979-986. doi: 10.1002/lt.20740
    [9] CANTù P, TARANTINO I, BALDAN A, et al. Endo-therapies for biliary duct-to-duct anastomotic stricture after liver transplantation: outcomes of a nationwide survey[J]. Liver Int, 2019, 39(7):1355-1362. DOI: 10.1111/liv.14010.
    [10] RÖNNING J, BERGLUND E, ARNELO U, et al. Long-term outcome of endoscopic and percutaneous transhepatic approaches for biliary complications in liver transplant recipients[J]. Transplant Direct, 2019, 5(3):e432. DOI: 10.1097/TXD.0000000000000869.
    [11] TAKAO S, MATSUO Y, SHINCHI H, et al. Magnetic compression anastomosis for benign obstruction of the common bile duct[J]. Endoscopy, 2001, 33(11):988-990. doi: 10.1055/s-2001-17923
    [12] MIMURO A, TSUCHIDA A, YAMANOUCHI E, et al. A novel technique of magnetic compression anastomosis for severe biliary stenosis[J]. Gastrointest Endosc, 2003, 58(2):283-287. doi: 10.1067/mge.2003.354
    [13] OKAJIMA H, KOTERA A, TAKEICHI T, et al. Magnet compression anastomosis for bile duct stenosis after duct-to-duct biliary reconstruction in living donor liver transplantation[J]. Liver Transpl, 2005, 11(4):473-475. doi: 10.1002/lt.20364
    [14] AKITA H, HIKITA H, YAMANOUCHI E, et al. Use of a metallic-wall stent in the magnet compression anastomosis technique for bile duct obstruction after liver transplantation[J]. Liver Transpl, 2008, 14(1):118-120. doi: 10.1002/lt.21273
    [15] MATSUNO N, UCHIYAMA M, NAKAMURA Y, et al. A nonsuture anastomosis using magnetic compression for biliary stricture after living donor liver transplantation[J]. Hepatogastroenterology, 2009, 56(89):47-49. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=c13e93a99e68103a9e42798c7303b5db
    [16] MARUBASHI S, NAGANO H, YAMANOUCHI E, et al. Salvage cystic duct anastomosis using a magnetic compression technique for incomplete bile duct reconstruction in living donor liver transplantation[J]. Liver Transpl, 2010, 16(1):33-37. DOI: 10.1002/lt.21934.
    [17] ITOI T, YAMANOUCHI E, IKEUCHI N, et al. Magnetic compression duct-to-duct anastomosis for biliary obstruction in a patient with living donor liver transplantation[J]. Gut Liver, 2010, 4 (Suppl 1):S96-S98. DOI: 10.5009/gnl.2010.4.S1.S96.
    [18] JANG SI, KIM JH, WON JY, et al. Magnetic compression anastomosis is useful in biliary anastomotic strictures after living donor liver transplantation[J]. Gastrointest Endosc, 2011, 74(5):1040-1048. DOI: 10.1016/j.gie.2011. 06.026.
    [19] ITOI T, KASUYA K, SOFUNI A, et al. Magnetic compression anastomosis for biliary obstruction: review and experience at Tokyo Medical University Hospital[J]. J Hepatobiliary Pancreat Sci, 2011, 18(3):357-365. DOI: 10.1007/s00534-010-0350-9.
    [20] OYA H, SATO Y, YAMANOUCHI E, et al. Magnetic compression anastomosis for bile duct stenosis after donor left hepatectomy: a case report[J]. Transplant Proc, 2012, 44(3):806-809.DOI: 10.1016/j.transproceed.2012.01. 021.
    [21] PEREZ-MIRANDA M, ALEMAN N, DE LA SERNA HIGUERA C, et al. Magnetic compression anastomosis through EUS-guided choledochoduodenostomy to repair a disconnected bile duct in orthotopic liver transplantation[J]. Gastrointest Endosc, 2014, 80(3):520-521. DOI: 10.1016/j.gie.2014.06.042.
    [22] JANG SI, RHEE K, KIM H, et al. Recanalization of refractory benign biliary stricture using magnetic compression anastomosis[J]. Endoscopy, 2014, 46(1):70-74. DOI: 10.1055/s-0033-1358907.
    [23] PARLAK E, KOKSAL AS, KUCUKAY F, et al. A novel technique for the endoscopic treatment of complete biliary anastomosis obstructions after liver transplantation: through-the-scope magnetic compression anastomosis[J]. Gastrointest Endosc, 2017, 85(4):841-847. DOI: 10.1016/j.gie.2016.07.068.
    [24] JANG SI, LEE KH, YOON HJ, et al. Treatment of completely obstructed benign biliary strictures with magnetic compression anastomosis: follow-up results after recanalization[J]. Gastrointest Endosc, 2017, 85(5):1057-1066. DOI: 10.1016/j.gie.2016.08.047.
    [25] 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, 2019, DOI: 10.1007/s00464-019-07063-8 [Epubahead of print].
    [26] 邱明龙, 高慧敏, 叶丹, 等.磁体差异性结构设计在磁压榨技术中的应用分析[J].中国医疗设备, 2019, 34(3): 1-4, 8. DOI: 10.3969/j.issn.1674-1633.2019.03.001.

    QIU ML, GAO HM, YE D, et al. Application analysis of differential structure design of magnet in magnetic compression technology[J]. Chin Med Devices, 2019, 34(3):1-4, 8. DOI: 10.3969/j.issn.1674-1633.2019.03.001.
    [27] 严小鹏, 商澎, 史爱华, 等.磁外科学体系的探索与建立[J].科学通报, 2019, 64(8) :815-826. http://www.cnki.com.cn/Article/CJFDTotal-KXTB201908008.htm

    YAN XP, SHANG P, SHI AH, et al. The exploration and establishment of the system of magnetic science[J]. Chin Sci Bull, 2019, 64(8) :815-826. http://www.cnki.com.cn/Article/CJFDTotal-KXTB201908008.htm
    [28] 田波彦, 刘豪, 付珊, 等.不同镀层钕铁硼磁体抗胆汁腐蚀的体外研究[J].现代生物医学进展, 2019, 19(6): 1006-1010, 1038. http://www.cnki.com.cn/Article/CJFDTotal-SWCX201906002.htm

    TIAN BY, LIU H, FU S, et al. In vitro study on bile corrosion resistance of NdFeB magnets with different coatings[J]. Prog Mod Biomed, 2019, 19(6):1006-1010, 1038. http://www.cnki.com.cn/Article/CJFDTotal-SWCX201906002.htm
    [29] 严小鹏, 史爱华, 王善佩, 等.磁压榨技术治疗复杂性胆道狭窄的临床应用探索[J].中华肝胆外科杂志, 2019, 25(3):237-240.DOI:10.3760/cma.j.issn.1007-8118. 2019.03.021.

    YAN XP, SHI AH, WANG SP, et al. Clinical application exploration of magnetic compression technology in the treatment of complex biliary strictures[J]. Chin J Hepatobiliary Surg, 2019, 25(3):237-240. DOI: 10.3760/cma.j.issn.1007-8118.2019.03.021.
    [30] 李宇, 孙昊, 严小鹏, 等.磁压榨吻合治疗六例良性胆管狭窄[J].中华消化杂志, 2018, 38(12):848-851. DOI: 10.3760/cma.j.issn.0254-1432.2018.12.012.

    LI Y, SUN H, YAN XP, et al. Treatment of six cases of benign bile duct stricture by magnetic compression anastomosis [J]. Chin J Dig Surg, 2018, 38(12):848-851. DOI: 10.3760/cma.j.issn.0254-1432.2018.12.012.
    [31] 李宇, 孙昊, 严小鹏, 等.磁压榨吻合治疗肝移植术后胆道吻合口狭窄[J].中华肝胆外科杂志, 2018, 24(9):577-580. DOI:10.3760/cma.j.issn.1007-8118. 2018.09.001.

    LI Y, SUN H, YAN XP, et al. Magnetic compression anastomosis for treatment of biliary anastomotic stricture after orthotopic liver transplantation[J]. Chin J Hepatobiliary Surg, 2018, 24(9):577-580. DOI: 10.3760/cma.j.issn.1007-8118.2018.09.001.
  • 加载中
图(5)
计量
  • 文章访问数:  31
  • HTML全文浏览量:  22
  • PDF下载量:  5
  • 被引次数: 0
出版历程
  • 收稿日期:  2019-11-30
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2020-01-15

目录

    /

    返回文章
    返回