The Experience Of Diagnosis And Treatment To Biliary Cast Syndrome In 103 Patients After Liver Transplantation.

ObjectiveTo summarize the experience of diagnosis and treatment to biliary cast syndrome in patients after othotopic liver transplantation.Materials and MethodsThe clinical manifestation, findings, therapeutic means and efficacy of 103 patients with biliary cast syndrome after orthotopic liver transplantation were retrospectively analyzed. Patients of post operation time <3m would undergo T tube drainage replaced with PTBD tube when obstruction of biliary tract became serious or accompanied with infection in bile duct. Endoscopic therapy would perform for post operation time≥3m patients.According to the injury level of biliary duct epithelium, patients were devided into six groups (Ⅰ-type,Ⅱ-type,Ⅲ-type,Ⅳ-type,Ⅴ-type andⅥ-type), and the supporting tube was set into the place where the necrosis present for three to six or twelve months. ALT,GGT,ALP,TB,DB in serum were determined a week pretreatment and a week posttreatment in each group. Data were analyzed with software SPSS11.5. All cases were followed up for twelve months. The place,degree and time after operation would be recorded when non-anastomotic biliary stricture was found.ResultsThere were 59 BCS cases in the general hospital of armed police force of China. The incidence rate of BCS was 9.08% . Many BCS showed off symptom such as jaundice, enriching in urine color, gray sedes, itch of skin and fever. Few were normal. In laboratory test, the serum ALT,GGT,ALP,TB,DB increased, total white cell count in peripheral blood did either. Visualization by T tube of biliary tract would show off filling defect. It may be found solid obturation of biliary tract by the check with optical fiber choledochoscope, accompanying or not with necrosis of biliary tract epithelium. 14 cases were found inⅠ-type and 18 inⅡ-type.In two groups, few indicators in serum (ALT,TB,DB) were in normal range, and others (GGT,ALP) were marked difference between twice tes(tP<0.05). There was no BC found anymore in the period of espial in two groups. No stricture was found in both group. 27 cases inⅢ-type and 23 cases inⅣ-type, the detected indicators were marked difference between twice checkout( P<0.05) . After supporting for 3~6m,there were 5 and 3 patients present as mild non-anastomotic biliary stricture inⅢ-type andⅣ-type group. In the groupⅤ-type, there were 13 patients. The detected indicators were descended after the treatment, few indicators in serum (ALT,TB,DB) were marked difference between twice test(P<0.05). After supporting for 6~12m, there were 4 patients present as moderate non-anastomotic biliary stricture in this group. There were 18 patients inⅥ-type group, no significant difference was found between twice check of the detected indicators in serum before the treatment and a week after (P>0.05). All patients in this group were found serious stricture up to three places that have not been sustaind in the period of espial. 9 died of MOSF, 1 died of AOSC, 8 had undergone retransplantation. In the retransplantation patients, 4 died of post operation MOSF, 3 recovered to normal, 1 patient was found BCS once more 15 d post the retransplantation and the third-transplantation was performed 7m post the second transplantation, no BCS was found again. The deaths total rate was 13.59%, death rate of retransplantation was 44%, total cure rate was 54%, total improvement rate was 71% and total stenosis rate was 29%.ConclusionThe final diagnosis of BCS depends on the detection result obtained with optical fiber choledochoscope and X ray. After endoscopic therapy and supporting in the necrosis spot, many BCS patients would get better in either symptom or biochemical indicator. BCS patients who found severe necrosis in biliary tract need retransplantation as early as possible.