| Research BackgroundSince its first clinical application in 1963,liver transplantation has become the ultimate option for the treatment of acute liver failure or end-stage liver disease.Although the survival rate of patients after liver transplantation has been significantly improved with the continuous improvement of surgical techniques,biliary complications after liver transplantation are still the main factors affecting the efficacy.Its high incidence and mortality seriously affect the survival time and quality of life of patients after liver transplantation.In the early stage of liver transplantation,biliary complications after liver transplantation are mainly treated by surgical operation.In recent years,with the continuous development of endoscopic techniques,endoscopic retrograde cholangiopancreatography(ERCP)is used to treat various kinds of biliary complications after liver transplantation.Although ERCP is the main treatment of biliary complications after liver transplantation,the results reported in the literature are different,especially for the treatment of bile duct stenosis.ObjectiveThis study aims to investigate the treatment,efficacy and safety of ERCP for various types of biliary complications after liver transplantation.MethodsClinical data of 83 patients treated with ERCP due to biliary complications after liver transplantation in the first affiliated hospital of Zhengzhou university from January 2013 to January 2018 were retrospectively analyzed,including 44 cases of bile duct stricture,of which anastomotic stenosis in 30 cases,non-anastomotic stenosis in 14 cases,29 cases of bile duct stones(including sediment sample stone),among them,16 cases were complicated with bile duct stenosis,10 cases of bile leakage.According to the types of biliary complications,the patients were divided into anastomotic stricture group,non-anastomotic stricture group,bile duct stone group and bile leakage group.General data,laboratory and imaging examinations,treatment method,treatment effect,postoperative complications of ERCP of patients with different types of biliary complications were observed,and SPSS 21.0 version was used for statistical analysis of the data.Results1?Patients with bile duct stenosis were treated by papillary sphincterotomy,bile duct dilation,nasobiliary drainage or plastic stent implantation,etc.Patients with simple choledocholithiasis were treated by sphincterotomy,basket or balloon lithotomy,nasobiliary drainage,etc.Patients with bile duct stones complicated with bile duct stenosis were treated with papillary sphincterotomy,bile duct dilation,balloon or basket stone extraction,and plastic stent implantation,etc.Patients with biliary leakage were treated by nasal bile duct drainage or plastic stent implantation,etc.2?A total of 195 ERCP treatments were performed in 83 patients,with an average(2.3±1.6)times/case.The average ERCP treatments in the anastomotic stenosis group were(3.2±1.8)times/case.The non-anastomotic stenosis group was(2.9±1.9)times/case.The bile duct stone group was(1.6±0.9)times/case.The bile leakage group was(1.6 ± 0.5)times/case.There was a statistically significant difference in the number of ERCP treatments between different types of biliary complications(P<0.05).Both the anastomotic stenosis group and the non-anastomotic stenosis group had more treatment times than the cholelithiasis group and the bile leakage group,and the difference was statistically significant(P<0.0083),while there was no statistically significant difference between the other groups(P>0.0083).In the anastomotic stenosis group,23 patients(76.7%)underwent bile duct dilation,with an average(3.5±1.5)times/case,and 30 patients(100%)underwent stent implantation,with an average(3.2±2.2)stents per patient.In the non-anastomotic stenosis group,9 patients(64.3%)underwent bile duct dilation with an average(2.7 ± 1.4)times/case,and 13 patients(92.9%)underwent stent implantation with an average(2.5±2.0)stents per patient.In the choledocholithiasis group,15 patients(51.7%)underwent bile duct dilatation,with an average(2.2±1.9)times/case,and 17 patients(58.6%)underwent stent implantation,with an average(2.0±1.2)stents per patient.In the bile leakage group,4 patients(40.0%)underwent biliary stent implantation,with 1 stent implantation for each patient.There was no statistically significant difference in the number of bile duct dilation and number of stent placement between different types of biliary complications(P>0.05).3?After treatment,total bilimbin(TBil),alanine aminotransferase(ALT)and glutamyl transpeptidase(GGT)of the patients in the anastomotic stenosis group all decreased,with statistically significant differences(P<0.05).TBil,ALT,aspartate transaminase(AST)and GGT were not decreased in the non-anastomotic stenosis group after treatment,and the difference was not statistically significant(P>0.05).TBil,ALT,AST and GGT of patients in the cholelithiasis group after ERCP treatment were all lower than those before treatment,and the difference was statistically significant(P<0.05).TBil,AST and GGT of patients in the bile leakage group decreased after treatment compared with that before treatment,and the difference was statistically significant(P<0.05).Among the 83 patients with biliary complications,60 cases(72.3%)were effectively treated and 23 cases(27.7%)were ineffectively.The treatment of anastomotic stenosis was effective in 23 cases(76.7%)and ineffective in 7 cases(23.3%).Non-anastomotic stenosis was effective in 4 cases(28.6%)and ineffective in 10 cases(71.4%).There were 24 cases(82.8%)effective and 5 cases(17.2%)ineffective in the treatment of cholelithiasis.Bile leakage treatment was effective in 9 cases(90.0%)and ineffective in 1 case(10.0%),and the difference in treatment effect between different types of biliary tract complications was statistically significant(P<0.05).ERCP treatment effect in the anastomotic stenosis group,bile duct stone group and bile leakage group was better than that in the non-anastomotic stenosis group,and the difference was statistically significant(P<0.0083),there was no statistically significant difference in efficacy between the other groups(P>0.0083)..Conclusions1?ERCP is a safe and effective method for the treatment of biliary complications after liver transplantation,different treatment methods were adopted for different types of biliary complications.2?Compared with other types of biliary complications,bile duct stenosis requires more times of ERCP treatment.Therefore,multiple endoscopic bile duct dilation combined with stent implantation is the key to successful treatment.3?The therapeutic effect of different types of biliary tract complications is different,and the ERCP effect of non-anastomotic stenosis is poor,so it is recommended to adopt other treatment methods as soon as possible. |
PDF Full Text Request