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Objective To summarize the experience in the diagnosis and treatment after liver transplantation biliary cast syndrome (BCS). Methods A retrospective analysis of 103 cases after liver transplantation in patients with clinical manifestations of BCS examination findings, treatment and outcome. Postoperative lt; 3m patients with severe obstructive symptoms or merge with biliary tract infection to PTBD outside drainage pipe to replace the T-tube. The postoperative ≥ 3m patients line Choledochofiberscope therapy. After removing the mold (BC), the anastomotic biliary epithelial necrosis, in order to support the tube support ~~ 6m. Patients seen by Choledochofiberscope check, in accordance with the degree of biliary epithelial damage is divided into six pathological type (Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ and Ⅵ type), statistics in each group of patients before treatment and after one week indicators of liver function enzymes (ALT, GGT, ALP, TB, DB), with SPSS11.5 software line statistical analysis. All patients were followed up to 12m, statistics anastomotic stenosis occurred time, location, extent. Results Of the 103 cases of BCS patients, the Armed Police General Hospital, 59 cases occurred, the hospital's total BCS incidence of 9.08%. BCS majority jaundice, dark urine, clay-colored stools, itchy skin and fever and other clinical manifestations; small number of clinical symptoms. Laboratory markers can be expressed as elevated liver function enzymes ALT, GGT, ALP, TB, DB, peripheral blood WBC rise. Angiography can show filling defect Choledochofiberscope is to check to see solid material filling the biliary tract, with or without biliary epithelial necrosis. 14 cases of type Ⅰ, Ⅱ 18 cases before and after treatment, ALT, TB, DB liver function enzymes within the normal range, GGT, ALP before and after treatment a significant difference (p lt; 0.05) during follow-up found no further BC and non-anastomotic stenosis. 27 cases of type Ⅲ, Ⅳ 23 cases, treatment of the biochemical indicators were reduced to near-normal range, the liver function before and after treatment, there is a significant difference (p lt; 0.05) 3 ~ 6m support tube support were five cases, three cases of mild non-anastomotic stenosis. Ⅴ type 13 cases, after treatment, the biochemical indicators have declined, ALT, TB, DB indicators before and after treatment there is a significant difference (p lt; 0.05), the support tube support 6 ~ 12m, 4 patients had moderate non-anastomotic stenosis. Ⅵ 18 cases after treatment of various biochemical indicators declined slightly, the liver function before and after treatment showed no significant difference (p gt; 0.05) in the follow-up period, all serious non-anastomotic stenosis, a total of eight cases The patients underwent liver retransplantation. 4 cases of perioperative died of multiple organ failure, 3 cases back to normal again after liver transplantation is not another BCS patients after liver transplantation, the BCS again, the line three times after liver transplantation not find BCS exists. The remaining nine cases failed again due to economic reasons transplant died of multiple organ failure, and 1 patient died of acute obstructive suppurative cholangitis. BCS 13.59% of the total mortality, retransplantation mortality rate was 44%. The overall cure rate of 54% total improvement rate of 71%, 29% of the total stricture rate. Conclusion 1, BCS by Choledochofiberscope examination and X-ray to confirm the diagnosis. 2, most of which can be taken by Choledochofiberscope BC and subsequent support tube support treatment to relieve the obstruction symptoms, and significantly improve the quality of life of the patients of the BCS, reduce again transplanted rate of BCS. 3, BC diffuse necrosis with hepatic bile duct as soon as possible retransplantation.
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