New diagnosis and therapy model for ischemic-type biliary lesions following liver transplantation--a retrospective cohort study.
New diagnosis and therapy model for ischemic-type biliary lesions following liver transplantation--a retrospective cohort study.
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肝移植术后缺血型胆道病变诊治新模式——回顾性队列研究
DOI：
10.1371/journal.pone.0105795
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Chen GH
中科院分区：
文献类型：
--
作者：
Zhang YC;Qu EZ;Ren J;Zhang Q;Zheng RQ;Yang Y;Chen GH
缺血型胆道病变（ITBL）是原位肝移植（OLT）后移植物丢失和死亡的主要原因。胆管血液供应受损可能会造成局灶性或广泛性损伤，导致肝内或肝外胆管狭窄或扩张，可通过超声检查、计算机断层扫描、磁共振胰胆管造影和胆管造影检测到。然而，放射学变化发生在晚期，即治疗干预的最佳时期之后。内镜逆行胰胆管造影（ERCP）和经皮肝穿刺胆管引流术（PTCD）是检测ITBL的金标准方法，但这些程序不能用于连续监测。传统的随访和诊断方法导致ITBLs的诊断和治疗延误。我中心自2008年2月开始采用早期诊断和干预模式（EDIM）对ITBL进行诊断和治疗。该模式主要包括预防性药物保护胆管上皮细胞膜、定期检测肝功能、每周监测超声造影（CEUS）以检测胆管缺血性改变。如果肝酶水平出现异常或CEUS显示动脉期肝门部胆管壁强化程度低或无强化，则应早期进行ERCP和PTCD以明确诊断并维持胆道引流。与2008年2月之前采用传统模式治疗的患者相比，EDIM组患者胆道感染发生率较低（28.6% vs. 48.6%，P = 0.04），肝移植存活时间较长（24±9.6个月 vs. 17±12.3个月，P = 0.02），ITBLs治疗后预后较好。
Ischemic-type biliary lesions (ITBLs) are a major cause of graft loss and mortality after orthotopic liver transplantation (OLT). Impaired blood supply to the bile ducts may cause focal or extensive damage, resulting in intra- or extrahepatic bile duct strictures or dilatations that can be detected by ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, and cholangiography. However, the radiographic changes occur at an advanced stage, after the optimal period for therapeutic intervention. Endoscopic retrograde cholangio-pancreatography (ERCP) and percutaneous transhepatic cholangiodrainage (PTCD) are the gold standard methods of detecting ITBLs, but these procedures cannot be used for continuous monitoring. Traditional methods of follow-up and diagnosis result in delayed diagnosis and treatment of ITBLs. Our center has used the early diagnosis and intervention model (EDIM) for the diagnosis and treatment of ITBLs since February 2008. This model mainly involves preventive medication to protect the epithelial cellular membrane of the bile ducts, regular testing of liver function, and weekly monitor of contrast-enhanced ultrasonography (CEUS) to detect ischemic changes to the bile ducts. If the liver enzyme levels become abnormal or CEUS shows low or no enhancement of the wall of the hilar bile duct during the arterial phase, early ERCP and PTCD are performed to confirm the diagnosis and to maintain biliary drainage. Compared with patients treated by the traditional model used prior to February 2008, patients in the EDIM group had a lower incidence of biliary tract infection (28.6% vs. 48.6%, P = 0.04), longer survival time of liver grafts (24±9.6 months vs. 17±12.3 months, P = 0.02), and better outcomes after treatment of ITBLs.
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影响因子：
19.7
作者：
DOPPMAN, JL;GIRTON, M;KAHN, ER
通讯作者：
KAHN, ER
DOI：
10.1111/j.1440-1746.1996.tb00005.x
发表时间：
1996-01-01
影响因子：
4.1
作者：
Feller, RB;Waugh, RC;McCaughan, GW
通讯作者：
McCaughan, GW
影响因子：
13.5
作者：
Hoekstra, H;Porte, RJ;Clavien, PA
通讯作者：
Clavien, PA
影响因子：
13.5
作者：
SANCHEZURDAZPAL, L;GORES, GJ;KROM, RAF
通讯作者：
KROM, RAF
影响因子：
2.9
作者：
Schlosser, T;Pohl, C;Tiemann, K
通讯作者：
Tiemann, K