肝移植术后复杂胆汁淤积型肝损伤的多学科综合诊疗

Multi-disciplinary team of complex cholestatic liver injury after liver transplantation

  • 摘要:
      目的  探讨多学科综合诊疗(MDT)在肝移植术后复杂胆汁淤积型肝损伤中的作用。
      方法  对吉林大学第一医院肝移植中心2020年6月23日收治的1例肝移植术后复杂胆汁淤积型肝损伤病例进行MDT讨论,明确病因及治疗策略,并总结MDT在肝移植术后复杂胆汁淤积型肝损伤治疗中的作用。
      结果  患者肝移植术后肝功能异常,先后明确诊断为胆道狭窄、排斥反应及胆道感染,内镜逆行胰胆管成像(ERCP)支架内外双引流、糖皮质激素冲击、抗感染等治疗效果不佳。经MDT讨论,明确诊断为肝移植术后复杂胆汁淤积型肝损伤,建议在病理辅助排除排斥反应基础上优化免疫抑制方案,行针对性抗感染治疗,并预防可能伴随出现的药物性肝损伤。后患者恢复良好,治愈出院。
      结论  肝移植术后复杂胆汁淤积型肝损伤病因复杂,病情动态变化,通过MDT讨论可提高对该疾病的认知和加强对诊治思路的梳理,提高治疗的针对性和有效性。

     

    Abstract:
      Objective  To investigate the role of multi-disciplinary team (MDT) in the treatment of complex cholestatic liver injury after liver transplantation.
      Methods  MDT consultation was conducted to clarify the causes and therapeutic strategies for one case of complex cholestatic liver injury after liver transplantation admitted to Liver Transplantation Center of the First Hospital of Jilin University on June 23, 2020. And the role of MDT in the treatment of complex cholestatic liver injury after liver transplantation was summarized.
      Results  The patient presented with abnormal liver function after liver transplantation. The diagnosis of biliary stricture, rejection and biliary tract infection was confirmed successively. Endoscopic retrograde cholangiopancreatography (ERCP) stent internal and external double drainage, glucocorticoid shock and anti-infection therapy yielded low clinical efficacy. After MDT consultation, complex cholestatic liver injury after liver transplantation was confirmed. It was suggested to optimize the immunosuppressive regimen based on the exclusion of rejections by pathological examination, deliver targeted anti-infection interventions and prevent the potential risk of concomitant drug-induced liver injury. The patient was discharged after proper recovery.
      Conclusions  The causes of complex cholestatic liver injury after liver transplantation are diverse, and the condition changes dynamically. MDT consultation are performed to deepen the understanding of this disease, strengthen the classification of diagnosis and treatment ideas and enhance the precision and efficacy of corresponding treatment.

     

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