Prevention, Diagnosis and Treatment of Biliary Tract Complications after Liver Transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHOU Jian , LI Li.

Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical College, Kunming 650101, China;

Corresponding author：

Keywords：

Liver transplantation Postoperative complication Biliary Prevention Diagnosis Treatment

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

【Abstract】ObjectiveTo investigate the causes of biliary tract complications after liver transplantation, and to put forward effective measures of prevention, diagnosis and treatment.
MethodsThe literatures of recent years were reviewed and summarized.
Results The causes of biliary tract complications after liver transplantation are very complex, and there are no standard preventive measures. Treatment differs according to causes.
ConclusionOne of the most important causes leading to biliary complications is preservative and ischemic injury. Poorly operative techniques and blood supply to biliary tract are also disastrous. Improving T tube placement can reduce the incidence of biliary complications related with T tube. To prevent biliary complications, it is crucial to completely wash the biliary tract， avoid damaging the blood supply to donor biliary tract and manage perfect biliary mucosatomucosa anastomosis without tension. T tube cholangiography combined with noninvasive MRCP enables accurate depiction of the biliary tree and diagnosis of biliary complications. Doppler ultrosonography should be routinely applied postoperatively. Timely application of interventional radiological technique is a valuable nonoperative procedure for treatment of biliary complications. Meanwhile, biliary sludge or cholestasis and mixed infections of biliary tract should be handled actively and properly.

Citation： ZHOU Jian,LI Li.. Prevention, Diagnosis and Treatment of Biliary Tract Complications after Liver Transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2006, 13(3): 365-368. doi: Copy

1.	Langenbecks Arch Chir Suppl Kongressbd， 1998; 115∶1560.
2.	Gastroenterol Clin North Am， 1993; 22(2)∶317.
3.	Moser MA, Wall WJ. Management of biliary problems after liver transplantation [J]. Liver Transpl， 2001; 7(11 Suppl 1)∶S46.
4.	郑树森，徐晓，吴健，等. 原位肝移植后胆道并发症的诊断与治疗 [J]. 中华器官移植杂志， 2002； 23（3）∶154.
5.	陆敏强, 陈规划, 黄洁夫. 不同热、冷缺血时间对供肝胆道保存的影响 [J]. 中山医科大学学报, 1998; 19(S1)∶18.
6.	陈规划，陆敏强，何晓顺，等. 原位肝移植术后胆道并发症的预防和诊治 [J]. 中华外科杂志， 2003； 41（1）∶3.
7.	SanchezUrdazpal L, Gores GJ, Ward EM, et al. Ischemictype biliary complications after orthotopic liver transplantation [J]. Hepatology, 1992； 16(1)∶49.
8.	Langrehr JM, Schneller A, Neuhaus R, et al. Etiologic factors and incidence of ischemic type biliary lesions (ITBL) after liver transplantation [J].
9.	Greif F, Bronsther OL, Thiel DHV, et al. The incidence, ti ming, and management of biliary tract complications after orthotopic liver transplantation [J]. Ann Surg, 1994； 219(1)∶40.
10.	Margarit C, Hidalgo E, Lazaro JL, et al. Biliary complications secondary to late hepatic artery thrombosis in adult liver transplant patients [J]. Transpl Int, 1998； 11(Suppl 1)∶S251.
11.	Sankary HN, McChesney L, Frye E, et al. A simple modification in operative technique can reduce the incidence of nonanastomotic biliary strictures after orthotopic liver transplantation [J]. Hepatology, 1995； 21(1)∶63.
12.	Ostroff JW. Posttransplant biliary problems [J]. Gastrointest Endosc Clin N Am， 2001； 11(1)∶163.
13.	朱志军, 张海明, 沈中阳，等. 肝移植术后非吻合口胆管狭窄相关危险因素的研究 [J]. 中华肝胆外科杂志， 2004； 10（8）∶552.
14.	Grewal HP, ShokouhAmiri MH, Vera S, et al. Surgical technique for right lobe adult living donor liver transplantation without venovenous bypass or portocaval shunting and with ducttoduct biliary reconstruction [J]. Ann Surg, 2001； 233(4)∶502.
15.	方善德, 曹绣虎，主编. 胆道外科的理论与实践 [M]. 第1版. 郑州: 河南科学技术出版社, 1991∶7~8.
16.	Randall HB, Wachs ME, Somberg KA, et al. The use of the T tube after orthotopic liver transplantation [J]. Transplantation, 1996； 61(2) ∶258.
17.	Donovan J. Nonsurgical management of biliary tract disease after liver transplantation [J].
18.	Rouch D, Emond J, Mayes J, et al. Choledochocholedochostomy without a T tube or internal stent in transplantation of the liver [J]. Surg Gynecol Obstet, 1990； 170(3)∶239.
19.	Randell H, Wachs M, Somberg K, et al. The use of the T tube after orthotopic liver transplantation [J]. Transplantation, 1996； 61(2)∶258.
20.	Scatton O, Meunier B, Cherqui D, et al. Randomized trial of choledochocholedochostomy with or without a T tube in orthotopic liver transplantation [J]. Ann Surg, 2001； 233(3)∶432.
21.	Park J S, Kim MH, Lee SK, et al. Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation [J]. Gastrointest Endosc, 2003； 57(1)∶78.
22.	Sawyer RG, Punch JD. Incidence and management of biliary complications after 291 liver transplants following the introduction of transcystic stenting [J]. Transplantation, 1998； 66(9)∶1201.
23.	严律南, 李波, 卢实春，等. 原位肝移植术后近期并发症的防治 [J]. 临床外科杂志， 2002； 10（6）∶333.
24.	O’Connor TP, Lewis WD, Jenkins RL. Biliary tract complications after liver transplantation [J]. Arch Surg, 1995； 130(3)∶312.
25.	Turrion VS, Alvira L G, Jimenez M, et al. Management of the biliary complications associated with liver transplantation: 13 years of experience [J]. Transplant Proc, 1999； 31(6)∶2392.
26.	汪根树, 陈规划, 何晓顺，等. 原位肝移植术后胆漏的诊断和治疗 [J]. 中华普通外科杂志， 2004； 19（12）∶713.
27.	Krawczyk M, Nyckowski P, Zieniewicz K, et al. Biliary complications following liver transplantation [J]. Transplant Proc, 2000； 32(6)∶1429.

1. Langenbecks Arch Chir Suppl Kongressbd， 1998; 115∶1560.
2. Gastroenterol Clin North Am， 1993; 22(2)∶317.
3. Moser MA, Wall WJ. Management of biliary problems after liver transplantation [J]. Liver Transpl， 2001; 7(11 Suppl 1)∶S46.
4. 郑树森，徐晓，吴健，等. 原位肝移植后胆道并发症的诊断与治疗 [J]. 中华器官移植杂志， 2002； 23（3）∶154.
5. 陆敏强, 陈规划, 黄洁夫. 不同热、冷缺血时间对供肝胆道保存的影响 [J]. 中山医科大学学报, 1998; 19(S1)∶18.
6. 陈规划，陆敏强，何晓顺，等. 原位肝移植术后胆道并发症的预防和诊治 [J]. 中华外科杂志， 2003； 41（1）∶3.
7. SanchezUrdazpal L, Gores GJ, Ward EM, et al. Ischemictype biliary complications after orthotopic liver transplantation [J]. Hepatology, 1992； 16(1)∶49.
8. Langrehr JM, Schneller A, Neuhaus R, et al. Etiologic factors and incidence of ischemic type biliary lesions (ITBL) after liver transplantation [J].
9. Greif F, Bronsther OL, Thiel DHV, et al. The incidence, ti ming, and management of biliary tract complications after orthotopic liver transplantation [J]. Ann Surg, 1994； 219(1)∶40.
10. Margarit C, Hidalgo E, Lazaro JL, et al. Biliary complications secondary to late hepatic artery thrombosis in adult liver transplant patients [J]. Transpl Int, 1998； 11(Suppl 1)∶S251.
11. Sankary HN, McChesney L, Frye E, et al. A simple modification in operative technique can reduce the incidence of nonanastomotic biliary strictures after orthotopic liver transplantation [J]. Hepatology, 1995； 21(1)∶63.
12. Ostroff JW. Posttransplant biliary problems [J]. Gastrointest Endosc Clin N Am， 2001； 11(1)∶163.
13. 朱志军, 张海明, 沈中阳，等. 肝移植术后非吻合口胆管狭窄相关危险因素的研究 [J]. 中华肝胆外科杂志， 2004； 10（8）∶552.
14. Grewal HP, ShokouhAmiri MH, Vera S, et al. Surgical technique for right lobe adult living donor liver transplantation without venovenous bypass or portocaval shunting and with ducttoduct biliary reconstruction [J]. Ann Surg, 2001； 233(4)∶502.
15. 方善德, 曹绣虎，主编. 胆道外科的理论与实践 [M]. 第1版. 郑州: 河南科学技术出版社, 1991∶7~8.
16. Randall HB, Wachs ME, Somberg KA, et al. The use of the T tube after orthotopic liver transplantation [J]. Transplantation, 1996； 61(2) ∶258.
17. Donovan J. Nonsurgical management of biliary tract disease after liver transplantation [J].
18. Rouch D, Emond J, Mayes J, et al. Choledochocholedochostomy without a T tube or internal stent in transplantation of the liver [J]. Surg Gynecol Obstet, 1990； 170(3)∶239.
19. Randell H, Wachs M, Somberg K, et al. The use of the T tube after orthotopic liver transplantation [J]. Transplantation, 1996； 61(2)∶258.
20. Scatton O, Meunier B, Cherqui D, et al. Randomized trial of choledochocholedochostomy with or without a T tube in orthotopic liver transplantation [J]. Ann Surg, 2001； 233(3)∶432.
21. Park J S, Kim MH, Lee SK, et al. Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation [J]. Gastrointest Endosc, 2003； 57(1)∶78.
22. Sawyer RG, Punch JD. Incidence and management of biliary complications after 291 liver transplants following the introduction of transcystic stenting [J]. Transplantation, 1998； 66(9)∶1201.
23. 严律南, 李波, 卢实春，等. 原位肝移植术后近期并发症的防治 [J]. 临床外科杂志， 2002； 10（6）∶333.
24. O’Connor TP, Lewis WD, Jenkins RL. Biliary tract complications after liver transplantation [J]. Arch Surg, 1995； 130(3)∶312.
25. Turrion VS, Alvira L G, Jimenez M, et al. Management of the biliary complications associated with liver transplantation: 13 years of experience [J]. Transplant Proc, 1999； 31(6)∶2392.
26. 汪根树, 陈规划, 何晓顺，等. 原位肝移植术后胆漏的诊断和治疗 [J]. 中华普通外科杂志， 2004； 19（12）∶713.
27. Krawczyk M, Nyckowski P, Zieniewicz K, et al. Biliary complications following liver transplantation [J]. Transplant Proc, 2000； 32(6)∶1429.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Prevention, Diagnosis and Treatment of Biliary Tract Complications after Liver Transplantation

Abstract Full text Figures/Tables Video References Cited by

Format

Content