肝臟移植、心臟移植及腎臟移植等已廣泛開展，大批受者長期存活。本文現(xiàn)就這組特殊人群在移植術(shù)后患膽道結(jié)石病的機(jī)理及其處理原則介紹如下。
1器官移植受體膽石病的發(fā)生機(jī)理
肝移植術(shù)后膽管結(jié)石與膽泥形成并引起膽道梗阻可隨時發(fā)生。除了明確的結(jié)石外，膽泥形成膽管鑄形并廣泛分布于肝內(nèi)膽管也有報道。膽管粘膜損害、膽管梗阻、移植肝的冷、熱缺血、感染及膽固醇過飽和等都在膽管結(jié)石形成過程中發(fā)揮作用，但膽管梗阻可能是肝移植術(shù)后膽管結(jié)石形成的最重要因素［1］。膽管結(jié)石和膽泥形成的患者，絕大多數(shù)都伴有膽管狹窄，這個狹窄可以發(fā)生在膽管膽管吻合口和膽管空腸吻合口，也可發(fā)生在非吻合口處的膽管。膽管內(nèi)異物如T型管或內(nèi)支撐管也可作為結(jié)石形成的核心。除了這些引起膽汁淤積的物理學(xué)原因外，環(huán)孢素A（CsA）在膽石發(fā)生中也起了作用［2］： 它可抑制膽汁分泌，促進(jìn)膽汁淤積，而FK506（普樂可復(fù)）似乎沒有這方面的副作用。此外，肝移植受者膽汁中膽固醇呈過飽和狀態(tài)，且T管引流及膽酸池的減少還加重這種狀態(tài)。目前還不清楚膽道重建方式對膽道結(jié)石形成有沒有影響。但從理論上講，膽腸吻合會增加腸源性細(xì)菌進(jìn)入膽道的機(jī)會，從而導(dǎo)致膽紅素去結(jié)合化，并進(jìn)一步形成色素石。但到底是膽管對端吻合還是膽腸吻合后更易形成結(jié)石，目前尚無詳盡研究。
引用本文： 文天夫,魏永剛,黃建文. 器官移植受體的膽石病. 中國普外基礎(chǔ)與臨床雜志, 2003, 10(4): 405-406. doi: 復(fù)制
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- 1. Tung BY, Kimmey MB. Biliary complications of orthotopic liver transplantation [J]. Dig Dis, 1999; 17(3)∶133.
- 2. Vessey DA, Kelley M. Related Articles. Inhibition of bile acid conjugation by cyclosporin A [J]. Biochim Biophys Acta， 1995; 1272(1)∶49.
- 3. Cao S, Cox K, So SS, Berquist W, et al. Potential effect of cyclosporin A in formation of cholesterol gallstones in pediatric liver transplant recipients [J]. Dig Dis Sci， 1997; 42(7)∶1409.
- 4. Ito T, Kimura T, Yamaguchi H, et al. Acute pancreatitis induced by cyclosporin A under stimulation of pancreas by caerulein [J]. Pancreas, 1993; 8(6)∶693.
- 5. Ganschow R. Cholelithiasis in pediatric organ transplantation: detection and management [J]. Pediatr Transplant, 2002; 6(2)∶91.
- 6. Schwartz DA, Petersen BT, Poterucha JJ, et al. Endoscopic therapy of anastomotic bile duct strictures occurring after liver transplantation [J]. Gastrointest Endosc, 2000; 51(2)∶169.
- 7. Richardson WS, Surowiec WJ, Carter KM, et al. Gallstone disease in heart transplant recipients [J]. Ann Surg, 2003; 237(2)∶273.
- 8. Graham SM,Flowers JL,Schweitzer E,et al. The utility of prophylactic laparoscopic cholecystectomy in transplant candidates [J]. Am J Surg, 1995; 169(1)∶44.
- 9. Melvin WS, Meier DJ, Elkhammas EA, et al. Prophylactic cholecystectomy is not indicated following renal transplantation [J]. Am J Surg, 1998; 175(4)∶317.