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;
YANGYu-long, Email: YYL516@126.com
Liver transplantation; Anastomotic stricture; Biliary injury; Biliary cast; Choledochoscope; Endoscopic
10.7507/1007-9424.20150377
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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

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