Endoscopic Observation and Treatment of Bile Duct Anastomotic Stricture and Biliary Injury Following Liver Transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHANGCheng ,  YANGYu-long , ZHANGHong-wei , MAYue-feng , LINMei-ju , SHILi-jun , LIJing-yi , YANGShi-ming

Department of Biliary Minimally Invasive Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, Liaoning Province, China;

Corresponding?author：

YANGYu-long, Email: YYL516@126.com

Keywords：

Liver transplantation; Anastomotic stricture; Biliary injury; Biliary cast; Choledochoscope; Endoscopic

DOI：

10.7507/1007-9424.20150377

Video：

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Objective To discuss the relation between bile duct anastomotic stricture and bile duct injury by endo-scopic observation following liver transplantation and it, s efficacy of endoscopic treatment. Method The clinical data of 24 cases of bile duct anastomotic stricture following liver transplantation diagnosed by cholangiography were analyzed retro-spectively. Results ①Twenty-four cases of bile duct anastomotic strictures were included in 3 cases of typeⅠa, 2 cases of typeⅠb, 4 cases of typeⅡ, 1 case of typeⅢa, 5 cases of typeⅢb, and 9 cases of typeⅢc.②The redness of intrahepatic bile duct mucosa, banding erosion, ulcer and fusion of anastomotic stricture mucosa could be seen in typeⅠa andⅢa. The redness of intrahepatic bile duct and anastomotic stricture mucosa could be seen in typeⅡwithout ulcer and fusion. The extensive erosion and ulcer of intrahepatic bile duct and redness of anastomotic stricture mucosa could be seen in typeⅢb. The extensive erosion, ulcer and partial necrosis of intrahepatic bile duct and anastomotic stricture mucosa could be seen in typeⅠb andⅢc.③Seventeen cases were cured by choledochoscopy through T tube, the biliary casts were moved out and the anastomotic strictures were relieved by balloon dilatation and placement of plastic stenting for 2 to 6 months, no recurrence happened. One case of typeⅠb treated by percutaneous transhepatic cholangial drainage(PTCD) and percuta-neous transhepatic cholangioscopy(PTCS) was developed into the stricture of typeⅡduring following-up for 19 months. Two cases of typeⅠa were treated by ERCP, the biliary casts were moved, one of which was cured, another 1 case was developed into the stricture of typeⅡduring following-up for 5 months. Two cases of typeⅡwere treated by ERCP, the biliary casts were moved, balloon dilatation and placement of plastic stent were performed, one of which was cured, another 1 case was recurrent during following-up for 1 months. The strictures were not relieved by multiple plastic stents for 4 to 6 months in 3 patients with recurrence and progress, but which was relieved by full-covered self-expanding removable metal stents for 4 to 7 months, there was no recurrence during following-up. One case of typeⅢb and one case of typeⅢc received the secondary open operation or choledochoscopy and placement of plastic stent for biliary infection and jaundice after the treatment of ERCP were cured. Conclusions Biliary stricture following liver transplantation accompanies different degree biliary injury. The slightest is typeⅡand typeⅠa, typeⅢa is the second, typeⅢb is more serious, and typeⅠb and typeⅢc are the worst. Choledochoscopy is a better choose for anastomotic strictures. ERCP is not a better choose for anastomotic strictures of typeⅠb, Ⅲb, andⅢc.

Citation： ZHANGCheng, YANGYu-long, ZHANGHong-wei, MAYue-feng, LINMei-ju, SHILi-jun, LIJing-yi, YANGShi-ming. Endoscopic Observation and Treatment of Bile Duct Anastomotic Stricture and Biliary Injury Following Liver Transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(12): 1434-1438. doi: 10.7507/1007-9424.20150377 Copy

1.	Starzl TE, Putnam CW, Hansbrough JF, et al. Biliary complications after liver transplantation: with special reference to the biliary cast syndrome and techniques of secondary duct repair. Surgery, 1977, 81(2): 212-221.
2.	胡冰, 于鳳海, 龔彪, 等.肝移植術后膽管吻合口狹窄的內鏡處理.中華消化內鏡雜志, 2008, 25(12): 643-647.
3.	楊玉龍, 張誠, 馬躍峰, 等.肝移植后膽管吻合口狹窄的分型及其臨床價值.中華器官移植雜志, 2015, 36(3): 156-160.
4.	Li S, Stratta RJ, Langnas AN, et al. Diffuse biliary tract injury after orthotopic liver transplantation. Am J Surg, 1992, 164(5): 536-540.
5.	Rizk RS, Mcvicar JP, Emond MJ, et al. Endoscopic management of biliary strictures in liver transplant recipients: effect on patient and graft survival. Gastrointest Endosc, 1998, 47(2): 128-135.
6.	Campbell WL, Sheng R, Zajko AB, et al. Introhepatic biliary strictures after liver transplantation. Radiology, 1994, 191(3): 735-740.
7.	楊玉龍, 張寶善, 馮秋實, 等.膽道內鏡對肝移植術后膽管損傷變化的觀察.中華肝膽外科雜志, 2010, 16(1): 19-22.
8.	Yang YL, Zhang C, Lin MJ, et al. Biliary casts after liver transplanta-tion: morphology and biochemical analysis. World J Gastroenterol, 2013, 19(43): 7772-7777.
9.	楊玉龍, 譚文翔, 劉振文, 等.利用膽道鏡輔助診治肝移植術后膽道損傷并發癥15例.中華器官移植雜志, 2009, 30(5): 313-314.
10.	于強, 楊玉龍, 林美舉, 等.經皮經肝膽道鏡治療肝移植術后膽管鑄型的安全性及其臨床價值觀察.中華消化內鏡雜志, 2011, 28(3): 146-149.
11.	Yang YL, Shi LJ, Lin MJ, et al. Clinical analysis and significance of cholangiography for biliary cast/stone after orthotopic liver transplantation. J Nanosci Nanotechnol, 2013, 13(1): 171-177.
12.	楊玉龍, 陳海龍, 譚文翔, 等.原位肝移植后膽管狹窄與膽道內鏡下球囊擴張及支撐管治療.中國組織工程研究與臨床康復, 2008, 12(31): 6181-6186.
13.	郭善禹, 孫建民, 姚德成.支撐導管內加壓防治膽腸吻合口狹窄的超微結構研究.中華外科雜志, 1995, 33(10): 626-627.
14.	張誠, 楊玉龍, 吳萍, 等.全覆膜自膨式可回收金屬支架治療膽腸吻合術后復發性吻合口狹窄.中華外科雜志, 2014, 52(4): 306-307.
15.	張誠, 楊玉龍, 吳萍, 等.全覆膜自膨式可回收金屬支架治療肝移植術后膽管吻合口狹窄.中華器官移植雜志, 2014, 35(10): 607-610.

1. Starzl TE, Putnam CW, Hansbrough JF, et al. Biliary complications after liver transplantation: with special reference to the biliary cast syndrome and techniques of secondary duct repair. Surgery, 1977, 81(2): 212-221.
2. 胡冰, 于鳳海, 龔彪, 等.肝移植術后膽管吻合口狹窄的內鏡處理.中華消化內鏡雜志, 2008, 25(12): 643-647.
3. 楊玉龍, 張誠, 馬躍峰, 等.肝移植后膽管吻合口狹窄的分型及其臨床價值.中華器官移植雜志, 2015, 36(3): 156-160.
4. Li S, Stratta RJ, Langnas AN, et al. Diffuse biliary tract injury after orthotopic liver transplantation. Am J Surg, 1992, 164(5): 536-540.
5. Rizk RS, Mcvicar JP, Emond MJ, et al. Endoscopic management of biliary strictures in liver transplant recipients: effect on patient and graft survival. Gastrointest Endosc, 1998, 47(2): 128-135.
6. Campbell WL, Sheng R, Zajko AB, et al. Introhepatic biliary strictures after liver transplantation. Radiology, 1994, 191(3): 735-740.
7. 楊玉龍, 張寶善, 馮秋實, 等.膽道內鏡對肝移植術后膽管損傷變化的觀察.中華肝膽外科雜志, 2010, 16(1): 19-22.
8. Yang YL, Zhang C, Lin MJ, et al. Biliary casts after liver transplanta-tion: morphology and biochemical analysis. World J Gastroenterol, 2013, 19(43): 7772-7777.
9. 楊玉龍, 譚文翔, 劉振文, 等.利用膽道鏡輔助診治肝移植術后膽道損傷并發癥15例.中華器官移植雜志, 2009, 30(5): 313-314.
10. 于強, 楊玉龍, 林美舉, 等.經皮經肝膽道鏡治療肝移植術后膽管鑄型的安全性及其臨床價值觀察.中華消化內鏡雜志, 2011, 28(3): 146-149.
11. Yang YL, Shi LJ, Lin MJ, et al. Clinical analysis and significance of cholangiography for biliary cast/stone after orthotopic liver transplantation. J Nanosci Nanotechnol, 2013, 13(1): 171-177.
12. 楊玉龍, 陳海龍, 譚文翔, 等.原位肝移植后膽管狹窄與膽道內鏡下球囊擴張及支撐管治療.中國組織工程研究與臨床康復, 2008, 12(31): 6181-6186.
13. 郭善禹, 孫建民, 姚德成.支撐導管內加壓防治膽腸吻合口狹窄的超微結構研究.中華外科雜志, 1995, 33(10): 626-627.
14. 張誠, 楊玉龍, 吳萍, 等.全覆膜自膨式可回收金屬支架治療膽腸吻合術后復發性吻合口狹窄.中華外科雜志, 2014, 52(4): 306-307.
15. 張誠, 楊玉龍, 吳萍, 等.全覆膜自膨式可回收金屬支架治療肝移植術后膽管吻合口狹窄.中華器官移植雜志, 2014, 35(10): 607-610.

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Endoscopic Observation and Treatment of Bile Duct Anastomotic Stricture and Biliary Injury Following Liver Transplantation

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