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Study of the Etiology and Treatment of Biliary Complications after Adult Orthotopic Liver Transplantation

Author: ZhaoFengZuo
Tutor: WanJun
School: PLA Postgraduate Medical School
Course: Internal Medicine
Keywords: Orthotopic Liver Transplantation OLT Biliary complications T-tube angiography Endoscopic Retrograde Cholangiopancreatography ERCP
CLC: R657.3
Type: Master's thesis
Year: 2011
Downloads: 15
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Abstract


Objective:To evaluate the etiology, precaution of biliary complications after adult Orthotopic Liver Transplantation (OLT), and to discuss the diagnosis and treatment of complications.Methods:Total 800 cases of OLT had been recruited from January 2005 to December 2009.78 cases with biliary complications were diagnosed after OLT. T-tube angiography was served as gold standard. Individualized therapy was performed.Results:The morbidity of biliary complication post OLT from 2005 to 2009 was 78/800 (9.75%),with 40/256(15.6%)in 2005,15/144(10.4%) in 2006,10/151(6.6%) in 2007, 8/148(5.4%) in 2008,5/101(5.0%) in 2009, respectively. T-tube and HAI, CMV inflamation, AR could significantly increase the morbidity of biliary complication. To liberalize blood supply of the portal vein and hepatic artery in the operation would reduce the morbidity of biliary complication. All the cause of biliary complication were identified by clinical symptom, color doppler ultrasound, MRCP, T-tube angiography, and Endoscopic Retrograde Cholangio pancreatography (ERCP). The aetiology of biliary complications data showed that 12 cases were bile leakage, complicated with bile duct stricture of bile leakage had 8 cases,12 cases were diagnosed on biliary anastomotic stritures, complicated with bile duct stone or bile thrombi had 28cases. On the other hand,7 cases were diagnosed on non-biliary anastomotic stritures.10 cases were confirmed bile cast syndrome, Oddi’s sphincter dysfunction had been confirmed for 1 cases.67 cases got successful results by expectant treatment or interventional therapy with T-tube.11 cases got successful results by pancreatocholangiography.73 cases got improved clinical symptom and liver function.5 cases were performed secondary liver transplantation, with 5.8% re-transplantation rate.Conclusion:The causes of bilary complications were multifactor, T-tube and HAI, CMV inflamation, AR could increase the incidence of bilary complications significantly. To aim directly at preservation according to etiological factors wound reduce the incidence of bilary complications. Total morbidity show reduce tendency year by year. The cure rate of biliary complication would increase by detecting and treating in the early stage. Different treatment measure of biliary tract complications should be taken according to various type and etiological factors. At present, the treatment strategy of biliary tract complications was focus on combined therapy in micro-invasive intervention.

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CLC: > Medicine, health > Surgery > Of surgery > Abdominal surgery > Liver and liver tube
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