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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

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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

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