探讨内镜下逆行性胰胆管造影术（ERCP）治疗肝移植术后胆道并发症的围手术期管理。

本前瞻性研究对象为2008年12月至2012年12月在中山大学附属第三医院消化内镜中心接受ERCP治疗的102例肝移植术后胆道并发症患者。其中男90例，女12例；年龄23～65岁，中位年龄56岁。所有患者均签署知情同意书，符合医学伦理学规定。术前给予患者针对性心理疏导、严格器械消毒、应用术前药物等积极准备，术中医护人员密切配合，术后给予禁食、输液、抗感染、制酸剂、生长抑素等对症处理，妥善固定鼻胆管，密切观察病情，出院后给予健康指导。

102例患者中成功获得ERCP治疗94例，成功率为92.2%（94/102）。94例患者治愈率77%（72/94），好转率20%（19/94），总有效率97%（91/94）。患者发生术后并发症15例，其中高淀粉酶血症8例、轻型胰腺炎4例、乳头肌切口出血3例，均经保守治疗痊愈。

术前积极心理疏导、术中医护人员密切配合、术后严密观察并发症情况及出院后健康指导为ERCP治疗肝移植术后胆道并发症成功的重要因素。

To investigate the perioperative management of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of biliary complications following liver transplantation (LT).

A total of 102 patients with biliary complications following LT undergoing ERCP in Digestive Endoscopy Center, the Third Affiliated Hospital of Sun Yat-sen University from December 2008 to December 2012 were included in this prospective study. There were 90 males and 12 females with the age ranging from 23 to 65 years old and a median of 56 years old. The informed consents of all patients were obtained and the ethical committee approval was received. Positive preoperative preparations were given to the patients: personalized psychological counseling, strict disinfection of surgical instruments, application of preoperative drugs, et al. The operators and nursing staff cooperated closely during the operation. Symptomatic treatments such as fasting, transfusion, anti-infection, antacids, somatostatin were given to the patients after operation. The nasobiliary ducts were properly fixed and the conditions were closely observed. Health guidance was given to the patients after hospital discharge.

In 102 patients, 94 patients were treated by ERCP successfully with the success rate of 92.2% (94/102). The curative rate was 77% (72/94), the improvement rate was 20% (19/94) and the total effective rate was 97% (91/94). Postoperative complications were observed in 15 cases including hyperamylasemia (n=8), mild pancreatitis (n=4), bleeding of the papillary muscles incision (n=3), and all were cured by conservative treatments.

Positive preoperative psychological counseling, close collaboration of medical staff during the operation, close observation on the postoperative complications and health guidance after hospital discharge are important factors for the success of ERCP in treating biliary complications following LT.