磁性压迫融合技术在原位肝移植术后胆道吻合口重度狭窄再通畅中的应用与配合技巧

Application value and cooperation skills of magnetic compression anastomosis for severe biliary strictures in orthotopic liver transplantation

摘要:

目的 探讨磁性压迫融合技术（MCA）在原位肝移植（OLT）后胆道吻合口重度狭窄中的应用及配合技巧。方法 回顾性分析1例OLT术后胆道吻合口重度狭窄的患者临床资料，该患者采用常规方法治疗失败后改用MCA治疗，在X线监视下通过经皮经肝穿刺胆道成像（PTC）和内镜下逆行胰胆管造影术（ERCP），分别在狭窄近端与远端各置入1枚磁铁，确认2枚磁铁位置及轴向与胆管长轴平行、磁铁近端及远端在同一条直线上后，缓慢释放磁铁。结果 7 d后2枚磁铁完全融合并移位，PTC证实胆管狭窄段已再通。再经ERCP去除磁铁，并置入胆道全覆膜金属支架。结论 MCA用于常规方法治疗失败的重度胆管狭窄和完全性胆道梗阻患者，可压迫狭窄部位组织，形成新通道，使胆管狭窄再通。

Abstract:

Objective To investigate the application value and skills of magnetic compression anastomosis (MCA) in severe biliary anastomotic stenosis due to orthotopic liver transplantation (OLT).Methods A retrospective analysis was performed on 1 patient with severe biliary anastomotic stenosis due to OLT who underwent MCA because of failure of conventional endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC). A magnet was placed in the proximal end of the stenosis and in the distal end of the stenosis by PTC and by ERCP, respectively. Be sure that the position and long axis of the two magnets were parallel to the long axis of the bile duct, then release the two the magnets.Results After 7 days, two magnets completely fused together and migrated. PTC showed that the anastomotic stenosis recanalized, the magnet was then removed and a fully covered metal stent was placed endoscopically.Conclusion MCA can be used in patients who fail to pass through severe biliary stricture using conventional method with ERCP or PTC. The MCA technique can compress the tissue of the stricture then form a new channel, and recanalization of bile duct stricture.