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SpyGlass直视系统在肝移植术后胆道狭窄诊治中的初步探索

赵东 张卓 黄一鸣 张毅 方泰石 金鑫 张康军 闫旭 曾新晨 姜楠

赵东, 张卓, 黄一鸣, 等. SpyGlass直视系统在肝移植术后胆道狭窄诊治中的初步探索[J]. 器官移植, 2022, 13(1): 55-60. doi: 10.3969/j.issn.1674-7445.2022.01.009
引用本文: 赵东, 张卓, 黄一鸣, 等. SpyGlass直视系统在肝移植术后胆道狭窄诊治中的初步探索[J]. 器官移植, 2022, 13(1): 55-60. doi: 10.3969/j.issn.1674-7445.2022.01.009
Zhao Dong, Zhang Zhuo, Huang Yiming, et al. Preliminary exploration of SpyGlass direct visualization system in diagnosis and treatment of biliary stricture after liver transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(1): 55-60. doi: 10.3969/j.issn.1674-7445.2022.01.009
Citation: Zhao Dong, Zhang Zhuo, Huang Yiming, et al. Preliminary exploration of SpyGlass direct visualization system in diagnosis and treatment of biliary stricture after liver transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(1): 55-60. doi: 10.3969/j.issn.1674-7445.2022.01.009

SpyGlass直视系统在肝移植术后胆道狭窄诊治中的初步探索

doi: 10.3969/j.issn.1674-7445.2022.01.009
基金项目: 

国家自然科学基金面上项目 81871999

深圳市科技研发基金面上项目 JCYJ20190809165813331

深圳市第三人民医院科研基金青年项目 G2021008

详细信息
    作者简介:

    赵东,男,1981年生,医学博士,研究方向为数字医学与肝移植的基础与临床研究,Email: zdong1233@126.com

    通讯作者:

    姜楠,男,1975年生,医学博士,研究方向为肝移植临床与基础研究,Email: njiang163@163.com

  • 中图分类号: R617, R445

Preliminary exploration of SpyGlass direct visualization system in diagnosis and treatment of biliary stricture after liver transplantation

More Information
  • 摘要:   目的  初步探讨SpyGlass直视系统在肝移植术后胆道狭窄诊治中的应用价值。  方法  收集4例因肝移植术后胆道狭窄接受SpyGlass直视系统检查患者的临床资料,分析其针对胆道狭窄的检查、治疗手段及相关预后。  结果  4例患者的彩色多普勒超声、磁共振胰胆管成像(MRCP)及内镜逆行胰胆管成像(ERCP)检查结果均提示胆道吻合口狭窄合并肝内胆道扩张,其中2例伴肝内胆道结石,3例在ERCP下反复多次放置胆道支架效果欠佳。SpyGlass直视系统检查结果提示胆道吻合口狭窄者4例,肝内胆道扩张者3例,肝内胆道结石者3例,胆汁呈脓性者2例,胆道有絮状物者3例;胆道壁充血水肿者1例,肝内胆道壁局部上皮坏死、僵硬改变者2例;1例患者由于胆道吻合口狭窄严重,导丝无法通过。4例患者分别接受胆道狭窄段切除+胆道结石取出+胆道端端吻合术、胆道狭窄段切除+胆肠吻合术、ERCP取石+胆道金属支架植入术和胆道金属支架植入术+经皮经肝穿刺胆管取石术进行治疗,病情均得到缓解,均未出现明显并发症,随访至投稿日,患者均存活。  结论  与传统影像学检查比较,SpyGlass直视系统可更加直观地显示胆道壁的形态学特征及胆道腔内的结构变化,是肝移植术后胆道狭窄的一种有效检查手段,并能针对不同胆道病变采取个体化治疗方式,有望改善患者预后。

     

  • 图  1  4例肝移植术后胆道狭窄患者的MRCP表现

    注:A图示例1肝内胆道扩张,胆道吻合口狭窄,肝内胆道结石(红色箭头),胆道远端小脓肿(白色箭头)可能;B图示例2肝内胆道扩张,胆道吻合口狭窄(白色箭头);C图示例3肝内胆道节段性扩张与狭窄(红色箭头),胆道吻合口狭窄(白色箭头);D图示例4肝内胆道扩张,胆道吻合口狭窄(红色箭头)。

    Figure  1.  MRCP manifestations in 4 patients with biliary stricture after liver transplantation

    图  2  SpyGlass直视下的胆道内部特征表现

    注:A图示SpyGlass直视系统的应用场景;B图示ERCP显示胆道吻合口狭窄(箭头);C图示胆道壁局部充血水肿改变(星号);D图示胆道内充满絮状物(箭头)和结石(星号);E图示胆道内堆满结石(星号),局部胆道壁呈苍白样改变;F图示局部胆道壁呈僵硬改变(星号);B~F图为例1的SpyGlass直视系统检查结果。

    Figure  2.  Internal features of the biliary tract under SpyGlass direct vision

    表  1  4例肝移植术后胆道狭窄患者的影像学检查结果

    Table  1.   Imaging results in 4 patients with biliary stricture after liver transplantation

    例序 性别 年龄(岁) 原发病 彩超 MRCP ERCP SpyGlass
    1 46 肝硬化合并肝细胞癌 肝内胆道扩张,胆道结石,小脓肿形成 肝内胆道扩张,胆道吻合口狭窄,肝内胆道结石,肝脓肿可能 肝内胆道扩张,胆道吻合口狭窄,肝内胆道结石 肝内胆道扩张,胆道吻合口瘢痕狭窄;胆汁呈脓性,胆道充满絮状物及结石;肝内胆道壁充血水肿,局部胆道上皮坏死、僵硬改变
    2 51 慢加急性肝衰竭 肝内胆道扩张 肝内胆道扩张,胆道吻合口狭窄 肝内胆道扩张,胆道吻合口狭窄 肝内胆道扩张,胆道吻合口瘢痕狭窄严重,胆道腔内有细小结石及絮状物
    3 49 慢加急性肝衰竭 肝内胆道扩张,胆道结石 肝内胆道节段性扩张与狭窄,胆道吻合口狭窄 肝内胆道扩张,胆道吻合口狭窄,肝内胆道结石 肝内胆道扩张,胆道吻合口瘢痕狭窄,肝内胆道结石;胆汁呈脓性,胆道腔内有絮状物,肝内局部胆道上皮坏死、僵硬改变
    4 49 慢加急性肝衰竭 肝内胆道扩张 肝内胆道扩张,胆道吻合口狭窄 肝内胆道扩张,胆道吻合口狭窄 胆道吻合口瘢痕狭窄严重,导丝无法置入
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  • 收稿日期:  2021-08-24
  • 网络出版日期:  2022-01-12
  • 刊出日期:  2022-01-15

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