Clinical Research Of Benign Bile Duct Strictures And Biliary Complications After Liver Transplantation

[Objective] To explore etiological factor , treatment outcome and main reas ons of biliary complications after liver transplantation. [ Methods ] 1. Two hund red and forty-two cases of benign biliary stricture treated in our hospital from 199 0 to 2005 were collected.Biliary stenosis circumstances under various injury fact ors and mechanism and treatment outcome were analyzed. 2.One hundred and th irty-three cases of liver transplantion treated in our hospital during 2002 and 200 5 were collected and investigate its main cuase.Firstly, incidence of biliary comp lications after liver transplantation was analysed. Secondly, circumstances of blee ding and coagulation function conditioning during perioperation were summaried and analyzed the relationship between them and biliary complications after liver tr ansplantation.Thirdly,28 cases of patients after liver transplantation from 2000 to 2005 were perfromed 41 times of liver biopsy. All specimen were examined path ologically stained with hematoxylin and eosin ,and Granzyme B, Fas-L immuno histochemical staining.Cases of acute or chronic rejection were confirmed.Then a nalyzsed connection between biliary complications and biliary ischemia. [ Resul ts] 1. Bliary stricture could been caused by various injury factors such as iatroge nic injury , biliary stones , trauma , chemical factor, etc. Of which, the rate of injury biliary stenosis due to cholecystectomy was 50.8% and 24% due to biliary stone. Treatment:Rate of cholangioenterostomy 69.4%, 21.9% of repair, 8.7 % of intervention.Rate of good therapeutic effect was 87.9%. 2. The occurrence rate of biliary complication after liver transplantation was 18%, of which accounted for only 29.2% of bile leakage, but biliary stenosis 70.8%; The cases within 1 month after transplantation were accounted for 62.5% .The main location of biliary stric ture were anastomosis (58.3%) and donor biliary system (50%) .Which due to he patic artery thrombosis were 7 cases(29.2%).The average amount of bleeding incases of Child C was 3000ml. There was 1.9% rate of biliary complication in the cases of intraoperative bleeding amount ≤ 1000ml.Bleeding amount within range of 1000～3000ml, rate of biliary complication was 20.5%.≥ 3000ml, 37.8% (P < 0. 01). For those cases of intraoperative hemodynamic instability the average am ount of bleeding were average 3200ml.their rate of postoperative biliary compli cations was 42.9%.For cases of hemodynamic stability, postoperative biliary com plication rate was 6.6% (P <0.01). Average bleeding amount was 2200ml and bili ary complication rate was 5% after early intervention by giving blood products a nd blood coagulation drug, and for late treatment was 4800ml and biliary compli cation rate was 72.2%.4. Total of 22 cases (78.6%) were detected clear rejection among 28 cases(41 times) liver biopsy specimens.Acute rejection was in 17 cases (60.7%); chronic rejection in 5 cases (17.9 %). There were 9( 52.9%) cases of bil iary complication in acute rejection occurrenced cases.To chronic rejection cases, there were 100% of hepatic artery stenosis and bile duct lost in pathological spec imen. [Conclusion] 1. Treatment outcome of benign bile duct strictures could be e ffectively increased by using appropriate operation occasion and mode on the ba sis of various cause and site of bile duct strictures .2.There major factors of bilia ry own particularity , biliary impaired blood supply and immune biliary injury were main causes of biliary complications after liver transplantation.3. Biliary ow n particularity was non-regeneration ability and scar repair of biliary epithelia af ter injury.Biliary impaired blood supply included partial liver artery damage and whole hepatic artery blood supply badness, even overall liver artery embolization. The former could come from such as iatrogenic injury, stones and drainage tube. The latter could caused by intraoperative hemodynamic disorders , hepatic artery thrombosis and other factors. 4. Biliary immune damage was related with acute or chronic rejection. Hepatic arterial occlusion or blood supply damage was importa nt in the mechenism of acute or chronic immune rejective injury.