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。
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.
作者
黄鹤宇
孙晓东
陈玉国
夏旭翔
吕国悦
Huang Heyu;Sun Xiaodong;Chen Yuguo;Xia Xuxiang;Lyu Guoyue(Liver Transplantation Center,the First Hospital of Jilin University,Changchun 130000,China)
出处
《器官移植》
CAS
CSCD
北大核心
2021年第6期720-726,共7页
Organ Transplantation
基金
吉林省科技发展计划项目(20190201268JC)。
关键词
肝移植
胆汁淤积
肝损伤
多学科综合诊疗
胆道狭窄
排斥反应
胆道感染
药物性肝损伤
Liver transplantation
Cholestasis
Liver injury
Multi-disciplinary team
Biliary stricture
Rejection
Biliary tract infection
Drug-induced liver injury
