Liver retransplantation for ischemic-type biliary lesions after orthotopic liver transplantation:a clinical report of 66 cases

BACKGROUND: Ischemic-type biliary lesions (ITBLs) play an extremely important role in influencing the long-term survival and quality of life of recipients after orthotopic liver transplantation (OLT). Some patients can be cured by interventional therapies, however others lose their grafts at last and receive liver retransplantation (re-OLT). The aim of this study was to analyze the data of 66 patients who had received re-OLT at our center because of ITBL and to discuss the treatment of ITBL after OLT. METHODS: We retrospectively analyzed 66 re-OLT cases due to ITBL from September 2001 to February 2007 at our center. The Kaplan-Meier method and the Cox-Mantel test were used to identify factors associated with mortality for univariate analysis and multivariate analysis, respectively. RESULTS: Fifty-five of 66 ITBL cases underwent interventional therapies before re-OLT. The actuarial survival at I month and I year for these patients was 83% and 74%, respectively. Prognostic factors for mortality in univariate analysis were model of end-stage liver disease score (MELD) >16.5 (chi(2)=5.856, P=0.016), cold ischemia time >8 hours (chi(2)=6.539, P=0.011), infections (chi(2)=5.550, P=0.018) and complications (chi(2)=12.168, P=0.002) after re-OLT. In the multivariate analysis (Cox regression), the risk factors independently associated with mortality were MELD score >16.5 (RR: 3.140; P=0.035), cold ischemia time >8.2 hours (RR: 0.192; P=0.016) and complications (RR: 3.896, P=0.003). CONCLUSIONS: The incidence of ITBL in China is higher than in other countries. Based on our experience, MELD score, cold ischemia time and complications after re-OLT are risk factors independently associated with mortality in retransplanted ITBL patients.

Preventive effects of autologous bone marrow mononuclear cell implantation on intrahepatic ischemic-type biliary lesion in rabbits

BACKGROUND: The ischemic-type biliary lesion (ITBL) is one of the most serious biliary complications of liver transplantation. This study aimed to investigate the effects of autologous bone marrow mononuclear cell (BM-MNC) implantation on neovascularization and the prevention of intrahepatic ITBL in a rabbit model. METHODS: The rabbits were divided into control, experimental model, and cell implantation groups, with 10 in each group. The model of intrahepatic ITBL was established by clamping the hepatic artery and common bile duct. Autologous BM-MNCs were isolated from the tibial plateau by density gradient centrifugation and were implanted through the common hepatic artery. Changes in such biochemical markers as aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyltranspeptidase, total bilirubin and direct bilirubin were measured. Four weeks after operation, cholangiography, histopathological manifestations, differentiation of BM-MNCs, microvessel density and the expression of vascular endothelial growth factor were assessed. RESULTS: Compared with the experimental model group, the BM-MNC implantation group showed superiority in the time to recover normal biochemistry. The microvessel density and vascular endothelial growth factor expression of the implantation group were significantly higher than those of the control and experimental model groups. The ITBL in the experimental model group was more severe than that in the implantation group and fewer new capillary blood vessels occurred around it. CONCLUSIONS: Implanted autologous BM-MNCs can differentiate into vascular endothelial cells, promote neovascularization and improve the blood supply to the ischemic bile duct, and this provides a new way to diminish or prevent intrahepatic ITBL after liver transplantation. (Hepatobiliary Pancreat Dis Int 2010; 9:593-599)

Risk factor for ischemic-type biliary lesion after ABO-incompatible living donor liver transplantation

AIM: To evaluate the risk factors for ischemic-type biliary lesion(ITBL) after ABO-incompatible(ABO-I) adult living donor liver transplantation(ALDLT).METHODS: Among 141 ALDLTs performed in our hospital between 2008 and 2014, 27(19%) were ABO-I ALDLT and 114 were ABO-identical/compatible ALDLT. In this study, we extensively analyzed the clinico-pathological data of the 27 ABO-I recipients to determine the risk factors for ITBL after ABO-I ALDLT. All ABO-I ALDLT recipients underwent an identical B-cell depletion protocol with preoperative rituximab, plasma exchange(PE), and operative splenectomy. The median follow-up period after transplantation was 26 mo. The clinical outcomes of the 27 ABO-I ALDLT recipients were compared with those of 114 ABO-identical/compatible ALDLT recipients.RESULTS: ITBL occurred in four recipients(14.8%) between 45 and 112 d after ABO-I ALDLT. The overall survival rates were not different between ABO-I ALDLT and ABO-identical/compatible ALDLT(P = 0.303). Among the ABO-I ALDLT recipients, there was no difference between patients with ITBL and those without ITBL in terms of B-cell and T-cell count, serum isoagglutinin titers, number of PEs, operative time and transfusion, use of graft infusion therapy, or number of remnant B-cell follicles and plasma cells in the spleen. However, the perioperative NK cell counts in the blood of patients with ITBL were significantly higher than those in the patients without ITBL(P < 0.05). Preoperative NK cell count > 150/μL and postoperative NK cell count > 120/μL were associated with greater relative risks(RR) for development of ITBL(RR = 20 and 14.3, respectively, P < 0.05). CONCLUSION: High NK cell counts in a transplant recipient's blood are associated with ITBL after ABO-I ALDLT. Further research is needed to elucidate the molecular mechanism of NK cell involvement in the development of ITBL.

Urokinase perfusion prevents intrahepatic ischemic-type biliary lesion in donor livers

AIM:To evaluate whether urokinase perfusion of non-heart-beating cadaveric donor livers reduces the incidence of intrahepatic ischemic-type biliary lesions(IITBLs).METHODS:A prospective study was conducted to investigate potential microthrombosis in biliary microcirculation when non-heart-beating cadaveric livers were under warm or cold ischemic conditions.The experimental group included 140 patients who underwent liver transplantation during the period of January 2006 to December 2007, and survived for more than 1 year.The control group included 220 patients who received liver transplantation between July 1999 and December 2005 and survived for more than 1 year.In the experimental group, the arterial system of the donor liver was perfused twice with urokinase during cold perfusion and after trimming of the donor liver.The incidence of IITBLs was compared between the two groups.RESULTS:In the control group, the incidence of IITBLs was 5.9%(13/220 cases) after 3-11 mo of transplantation.In the experimental group, two recipients(1.4%) developed IITBLs at 3 and 6 mo after transplantation, respectively.The difference in the incidence between the two groups was statistically signiflcant(P < 0.05).CONCLUSION:Double perfusion of cadaveric livers from non-heart-beating donors with urokinase mayreduce the incidence of IITBLs.

Machine perfusion and the prevention of ischemic type biliary lesions following liver transplant:What is the evidence?

The widespread uptake of different machine perfusion(MP)strategies for liver transplant has been driven by an effort to minimize graft injury.Damage to the cholangiocytes during the liver donation,preservation,or early posttransplant period may result in stricturing of the biliary tree and inadequate biliary drainage.This problem continues to trouble clinicians,and may have catastrophic consequences for the graft and patient.Ischemic injury,as a result of compromised hepatic artery flow,is a well-known cause of biliary strictures,sepsis,and graft failure.However,very similar lesions can appear with a patent hepatic artery and these are known as ischemic type biliary lesions(ITBL)that are attributed to microcirculatory dysfunction rather than main hepatic arterial compromise.Both the warm and cold ischemic period duration appear to influence the onset of ITBL.All of the commonly used MP techniques deliver oxygen to the graft cells,and therefore may minimize the cholangiocyte injury and subsequently reduce the incidence of ITBL.As clinical experience and published evidence grows for these modalities,the impact they have on ITBL rates is important to consider.In this review,the evidence for the three commonly used MP strategies(abdominal normothermic regional perfusion[A-NRP],hypothermic oxygenated perfusion[HOPE],and normothermic machine perfusion[NMP])for ITBL prevention has been critically reviewed.Inconsistencies with ITBL definitions used in trials,coupled with variations in techniques of MP,make interpretation challenging.Overall,the evidence suggests that both HOPE and A-NRP prevent ITBL in donated after circulatory death grafts compared to cold storage.The evidence for ITBL prevention in donor after brain death grafts with any MP technique is weak.

Establishment of an animal model of ischemic type intrahepatic biliary lesion in rabbits

AIM:To explore a method to establish an animal model of ischemic type intrahepatic biliary lesion in rabbits. METHODS:Forty Japanese white rabbits of clean grade were divided randomly into four groups(10 rabbits per group)including sham operation(SO) group,and artery-bile obstruction(ABO)-1 h group, ABO-2 h group and ABO-3 h group.All the rabbits in this study underwent the same initial surgical procedure in which the liver was prepared as for graft removal during liver transplantation.Subsequently in the SO group,no additional vascular intervention was performed,while in groups ABO-1 h,ABO-2 h and ABO-3 h,the animals underwent combined clamping of the hepatic artery and common bile duct with microvascular clips for 1,2 and 3 h,respectively.After the scheduled occlusion time,the clip was removed to recover blood supply.The animals were killed 4 wk after operation.The survival rate,liver function, cholangiography and histopathological manifestation of the rabbits in each group were observed. RESULTS:The survival rate was 100%in groups SO,ABO-1 h and ABO-2 h,while it was 60%in group ABO-3 h.At each observation time,the change degree of the indexes of liver function was proportional to the clamping time(ABO-3 h>ABO-2 h>ABO-1 h> SO,P<0.05).Cholangiographical and histopathologic manifestations both showed that intrahepatic biliary lesion aggravated proportionally with the increase of the clamping time. CONCLUSION:An animal model of ischemic type intrahepatic biliary lesion in rabbits is successfully established,which may provide a reliable technique for basic and clinical research into the etiology, development and prophylaxis of ischemic type intrahepatic biliary lesion after liver transplantation.

Pancreatic transection from blunt trauma associated with vascular and biliary lesions: A case report

Major injuries of the pancreas may result in considerable morbidity and mortality when associated with vascular and visceral injuries. In such cases, a right diagnosis and a prompt surgical intervention are necessary to give a chance to the patient. We herein describe a case of blunt abdominal trauma in a 29-year- old man whose pancreatic rupture was associated with hepatic artery, splenic vein and extrahepatic bile duct damage. Immediate surgery was performed after computer tomograghy (CT), the haemorrhagic lesions dictat the emergency transfer to the operating room. Spleno-pancreatic resection was done with reconstruction of the hepatic artery, ligation of the splenic vein and a Roux-en-Y bilio-jejunal diversion. The early post-operative course was complicated by stenosis of the arterial reconstruction, which was treated by endovascular angioplasty followed by percutaneous drainage of symptomatic pseudocyst, rest and antibiotics. Finally, the patient was discharged and was alive without clinical problems at the time when we wrote this case report. The present case underlines the clinical relevance of vascular and visceral injuries associated with pancreatic trauma and the problems arising in the diagnostic evaluation and the surgical strategy of complex multiple visceral and vascular lesions in blunt abdominal trauma.

Administration of granulocyte colony stimulating factor after liver transplantation leads to an increased incidence and severity of ischemic biliary lesions in the rat model

瞄准：最近，粒细胞殖民地刺激因素(G-CSF ) 罐头在健康骨髓施主导致 hypercoagulability，这被报导了。prothrombotic 的正式就职与已经损害的灌注在机关接枝的一个接受者声明原因可能在移植机关推进恶化，是想得到的。这研究评估了 G-CSF 治疗是否变得更坏在老鼠的肝灌注追随者肝移植当模特儿。方法：一个化为动脉血得非的老鼠肝移植模特儿被雇用在 syngeneic 和 allogeneic 紧张联合在肝上评估 G-CSF 治疗的效果。学习结果包括了由肝酶和肝组织学调查了的生存时间和肝损坏。观察时间是 1 d， 1 wk 和 12 wk。结果：与 G-CSF 对待的老鼠增加了胆汁的损坏追随者肝移植的发生和严厉。在这些动物，肝细胞坏死在小叶中心区域被加重。这些损害在 G-CSF 的损害灌注是指示的对待的动物。结论：当治疗可能提高先存在的、未被发现的灌注问题并且最终导致局部缺血， G-CSF 应该在肝移植的接受者小心地被使用导致的胆汁的复杂并发症。

Biliary complications in orthotopic liver transplantation:mechanism,diagnosis and treatment

Biliary complicationsfBC） are a major cause of morbidity in liver transplant recipients with an incidence of 10-30% following orthotopic liver transplantation（OLT）, and a mortality rate of up to 10%. The most common biliary complications are bile leaks, biliary strictures, ampullary dysfunction, and stones. Leaks predominate in the early posttransplant period; while stricture formation typically develops gradually over time. Risk factors for biliary complications comprise technical failure, T-tube-related complications, hepatic artery thrombosis, bleeding, ischemia/reperfusion injury, primary diseases, and other immunological, non-immunological, and infectious complications. Cholangiography, such as endoscopic retrograde cholangiopancreatograpby（ERCP） or percutaneous transhepatic cholangiogram（PTC）, is considered the gold standard for identifying post-transplant BC. The management of biliary complications after OLT requires a multidisciplinary approach, in which interventional radiology and endoscopic techniques are emerging as the preferred treatment option, but in a selected majority of patients, surgery is still necessary.

肝脏占位病变患者增强MRI胆道系统图像质量最佳翻转角探讨

目的探讨肝脏占位病变患者增强磁共振成像(MRI)胆道系统图像质量的最佳翻转角(FA)。方法2019年7月~2023年7月我院收治的肝脏占位病变患者60例,使用飞利浦Ingenia 3.0扫描仪行钊塞酸二钠(Gd-EOB-DTPA)增强扫描,设置翻转角分别为9°、20°、30°、45°和60°。评估不同翻转角状态下胆道系统胆道显影、伪影、信噪比和对比噪声比的差异。结果在FA=45°和60°时,胆道显影评分分别为(3.4±0.9)和(3.6±1.0),均显著高于9°、20°和30°时【分别为(2.7±0.5)、(2.9±0.8)和(3.2±0.8),P<0.05】,随着翻转角的增大,胆道显影评分越来越高,即图像质量越来越好;在胆道系统客观评价方面,各FA时胆囊、肝总管、胆总管信噪比比较差异均具有统计学意义(P<0.05);当FA=30°、45°和60°时,胆囊、左肝管、右肝管、肝总管和胆总管信噪比均显著高于FA=9°时(P<0.05);当FA=45°时,胆囊、右肝管、肝总管平均信噪比最佳,而FA=30°时左肝管和胆总管平均信噪比最佳;各FA时胆囊、肝总管、胆总管对比信噪比比较差异均具有统计学意义(P<0.05);当FA=30°、45°和60°时,胆囊、左肝管、右肝管、肝总管和胆总管对比信噪比均显著高于FA=9°时(P<0.05);当FA=45°时,胆囊、右肝管、肝总管和胆总管平均对比信噪比最佳,而FA=30°时左肝管平均对比信噪比最佳。结论在3T延迟成像方面,GdEOB-DTPA增强扫描肝胆管T1加权成像的最佳FA为45°,这一发现可作为临床胆道MR成像的参数设置依据,以提高胆道系统成像质量。

Biliary complications in liver transplantation: Impact of anastomotic technique and ischemic time on short- and long-term outcome

AIM: To elucidate the impact of various donor recipient and transplant factors on the development of biliary complications after liver transplantation.METHODS: We retrospectively reviewed 200 patients of our newly established liver transplantation(LT) program, who received full size liver graft. Biliary reconstruction was performed by side-to-side(SS), end-to-end(EE) anastomosis or hepeaticojejunostomy(HJ). Biliary complications(BC), anastomotic stenosis, bile leak, papillary stenosis, biliary drain complication, ischemic type biliary lesion(ITBL) were evaluated by studying patient records, corresponding radiologic imaging and reports of interventional procedures [e.g., endoscopic retrograde cholangiopancreatography(ERCP)]. Laboratory results included alanine aminotransferase(ALT), gammaglutamyltransferase and direct/indirect bilirubin with focus on the first and fifth postoperative day, six weeks after LT. The routinely employed external bile drain was examined by a routine cholangiography on the fifth postoperative day and six weeks after transplantation as a standard procedure, but also whenever clinically indicated. If necessary, interventional(e.g., ERCP) or surgical therapy was performed. In case of biliary complication, patients were selected, assigned to different complication-groups and subsequently reviewed in detail. To evaluate the patients outcome, we focussed on appearance of postoperative/post-interventional cholangitis, need for rehospitalisation, retransplantation, ITBL or death caused by BC.RESULTS: A total of 200 patients [age: 56(19-72), alcoholic cirrhosis: n = 64(32%), hepatocellular carcinoma: n = 40(20%), acute liver failure: n = 23(11.5%), cryptogenic cirrhosis: n = 22(11%), hepatitis B virus /hepatitis C virus cirrhosis: n = 13(6.5%), primary sclerosing cholangitis: n = 13(6.5%), others: n = 25(12.5%) were included. The median follow-up was 27 mo until June 2015. The overall biliary complication rate was 37.5%(n = 75) with anastomotic strictures(AS): n = 38(19%), bile leak(BL): n = 12(6%), biliary drain complication: n = 12(6%); papillary stenosis(PS): n = 7(3.5%), ITBL: n = 6(3%). Clinically relevant were only 19%(n = 38). We established a comprehensive classification for AS with four grades according to clinical relevance. The reconstruction techniques [SS: n = 164, EE: n = 18, HJ: n = 18] showed no significant impact on the development of BCs in general(all n < 0.05), whereas in the HJ group significantly less AS were found(P = 0.031). The length of donor intensive care unit stay over 6 d had a significant influence on BC development(P = 0.007, HR = 2.85; 95%CI: 1.33-6.08) in the binary logistic regression model, whereas other reviewed variables had not [warm ischemic time > 45 min(P = 0.543), cold ischemic time > 10 h(P = 0.114), ALT init > 1500 U/L(P = 0.631), bilirubin init > 5 mg/d L(P = 0.595), donor age > 65(P = 0.244), donor sex(P = 0.068), rescue organ(P = 0.971)]. 13%(n = 10) of BCs had no therapeutic consequences, 36%(n = 27) resulted in repeated lab control, 40%(n = 30) received ERCP and 11%(n = 8) surgical therapy. Fifteen(7.5%) patients developed cholangitis [AS(n = 6), ITBL(n = 5), PS(n = 3), biliary lesion BL(n = 1)]. One patient developed ITBL twelve months after LT and subsequently needed retransplantation. Rehospitalisation rate was 10.5 %(n = 21) [AS(n = 11), ITBL(n = 5), PS(n = 3), BL(n = 1)] with intervention or reinterventional therapy as main reasons. Retransplantation was performed in 5(2.5%) patients [ITBL(n = 1), acute liver injury(ALI) by organ rejection(n = 3), ALI by occlusion of hepatic artery(n = 1)]. In total 21(10.5%) patients died within the follow-up period. Out of these, one patient with AS developed severe fatal chologenic sepsis after ERCP.CONCLUSION: In our data biliary reconstruction technique and ischemic times seem to have little impact on the development of BCs.

Impact of machine perfusion of the liver on post-transplant biliary complications: A systematic review

AIM To review the clinical impact of machine perfusion(MP) of the liver on biliary complications post-transplantation, particularly ischaemic-type biliary lesions(ITBL). METHODS This systematic review was performed in accordance with the Preferred Reporting Systematic Reviews and MetaAnalysis(PRISMA) protocol. The following databases were searched: PubMed, MEDLINE and Scopus. The keyword "liver transplantation" was used in combination with the free term "machine perfusion". Clinical studies reporting results of transplantation of donor human livers following ex situ or in situ MP were analysed. Details relating to donor characteristics, recipients, technique of MP performed and post-operative biliary complications(ITBL, bile leak and anastomotic strictures) were critically analysed.RESULTS Fifteen articles were considered to fit the criteria for this review. Ex situ normothermic MP was used in 6 studies, ex situ hypothermic MP in 5 studies and the other 4 studies investigated in situ normothermic regional perfusion(NRP) and controlled oxygenated rewarming. MP techniques which have per se the potential to alleviate ischaemia-reperfusion injury: Such as hypothermic MP and NRP, have also reported lower rates of ITBL. Other biliary complications, such as biliary leak and anastomotic biliary strictures, are reported with similar incidences with all MP techniques. There is currently less clinical evidence available to support normothermic MP as a mitigator of biliary complications following liver transplantation. On the other hand, restoration of organ to full metabolism during normothermic MP allows assessment of hepatobiliary function before transplantation, although universally accepted criteria have yet to be validated.CONCLUSION MP of the liver has the potential to have a positive impact on post-transplant biliary complications, specifically ITBL, and expand extended criteria donor livers utilisation.

Liver biochemistry profile,significance and endoscopic management of biliary tract complications post orthotopic liver transplantation

AIM: To correlate the significance of liver biochemical tests in diagnosing post orthotopic liver transplantation (OLT) biliary complications and to study their profile before and after endoscopic therapy. METHODS: Patients who developed biliary complications were analysed in detail for the clinical information,laboratory tests,treatment offered,response to it,follow up and outcomes. The profile of liver enzymes was determined. The safety,efficacy and outcomes of endoscopic retrograde cholangiography (ERC) were also analysed. RESULTS: 40 patients required ERC for 70 biliary complications. GGT was found to be > 3 times (388.1 ± 70.9 U/mL vs 168.5 ± 34.2 U/L,P = 0.007) and SAP > 2 times (345.1 ± 59.1 U/L vs 152.7 ± 21.4 U/L,P = 0.003) the immediate post OLT values. Most frequent complication was isolated anastomotic strictures in 28 (40%). Sustained success was achieved in 26 (81%) patients. CONCLUSION: Biliary complications still remain an important problem post OLT. SAP and GGT can be used as early,non-invasive markers for diagnosis and also to assess the adequacy of therapy. Endoscopic management is usually effective in treating the majority of these biliary complications.

Complex liver retransplantation to treat graft loss due to long-term biliary tract complication after liver transplantation: A case report

BACKGROUND Loss of graft function after liver transplantation(LT) inevitably requires liver retransplant. Retransplantation of the liver(Re LT) remains controversial because of inferior outcomes compared with the primary orthotopic LT(OLT).Meanwhile, if accompanied by vascular complications such as arterial and portal vein(PV) stenosis or thrombosis, it will increase difficulties of surgery. We hereby introduce our center’s experience in Re LT through a complicated case of ReLT.CASE SUMMARY We report a patient who suffered from hepatitis B-associated cirrhosis and underwent LT in December 2012. Early postoperative recovery was uneventful.Four months after LT, the patient’s bilirubin increased significantly and he was diagnosed with an ischemic-type biliary lesion caused by hepatic artery occlusion. The patient underwent percutaneous transhepatic cholangial drainage and repeatedly replaced intrahepatic biliary drainage tube regularly for 5 years.The patient developed progressive deterioration of liver function and underwent liver re-transplant in January 2019. The operation was performed in a classic OLT manner without venous bypass. Both the hepatic artery and PV were occluded and could not be used for anastomosis. The donor PV was anastomosed with the recipient’s left renal vein. The donor hepatic artery was connected to the recipient’s abdominal aorta. The bile duct reconstruction was performed in an end-to-end manner. The postoperative process was very uneventful and the patient was discharged 1 mo after retransplantation.CONCLUSION With the development of surgical techniques, portal thrombosis and arterial occlusion are no longer contraindications for ReLT.

Risk factors and clinical indicators for the development of biliary strictures post liver transplant:Significance of bilirubin

AIM To identify risk factors associated with the formation of biliary strictures post liver transplantation over a period of 10-year in Queensland.METHODS Data on liver donors and recipients in Queensland between 2005 and 2014 was obtained from an electronic patient data system.In addition,intra-operative and post-operative characteristics were collected and a logistical regression analysis was performed to evaluate their association with the development of biliary strictures.RESULTS Of 296 liver transplants performed,285(96.3%) were from brain dead donors.Biliary strictures developed in 45(15.2%) recipients.Anastomotic stricture formation(n = 25,48.1%) was the commonest complication,with 14(58.3%) of these occurred within 6-mo of transplant.A percutaneous approach or endoscopic retrograde cholangiography was used to treat 17(37.8%) patients with biliary strictures.Biliary reconstruction was initially or ultimately required in 22(48.9%) patients.In recipients developing biliary strictures,bilirubin was significantly increased within the first postoperative week(Day 7 total bilirubin 74 μmol/L vs 49 μmol/L,P = 0.012).In both univariate and multivariate regression analysis,Day 7 total bilirubin > 55 μmol/L was associated with the development of biliary stricture formation.In addition,hepatic artery thrombosis and primary sclerosing cholangitis were identified as independent risk factors.CONCLUSION In addition to known risk factors,bilirubin levels in the early post-operative period could be used as a clinical indicator for biliary stricture formation.

Strategies in secondary biliary fibrosis

The cellular and molecular mechanisms that mediate hepatic fibrosis have provided a framework of different therapeutic foci to prevent, delay or in such case revert fibrosis and cirrhosis. The fundamental event in development of hepatic fibrosis caused by secondary biliary cholestasis is based on activation of the hepatic stellar cells (HSC) which the primary function is forming fibrosis. The activated HSC cells transform into myofibroblasts with capacity to produce alpha smooth muscle actin (α-SMA). As a result, the HSC activates proliferation of the cholangiocytes and epithelial cells whose functions represent important anti-fibrotic objectives. Some strategies are described as targeting against molecule involved in fibrosis production;and some medications with anti-fibrotic functions that are actually available in the medical arsenal have been tested in experimental animal models and in few clinical studies, and their components act in relation to the fibrotic cascade. In the end, the treatment strategies for hepatic fibrosis can vary on an individual basis depending on the etiology, the risk of fibrosis progression and the predominant pathogenic medium, which indicates that a multi-factorial approach could be necessary. Orthotopic liver transplant continues being the last final alternative for hepatic insufficiency from any cause;however, in no way does it supersede healthy natural liver in survival and adequate function. The investigative arsenal continues to develop rapidly, giving rise to other possible objectives in pre-clinical studies of conceptual trials, such as the utilization of molecular, cellular, drugs therapy and Chinese herbs. Despite being aforementioned, there are no existing ideal alternatives that completely reverse fibrosis in humans. Future usefulness of the majority of management alternatives seems probable and could be feasible.

多层螺旋CT 3D成像联合增强扫描对胆道梗阻性病变的诊断价值

目的 探讨多层螺旋CT 3D成像联合CT增强扫描诊断胆道梗阻性病变的价值。方法 回顾性选取2019年6月至2022年6月在商丘市第四人民医院接受手术治疗的70例胆道梗阻性病变患者的临床资料,所有患者术前均接受多层螺旋CT 3D成像、CT增强扫描检查,以手术病理检查结果为金标准,分析多层螺旋CT 3D成像联合CT增强扫描诊断胆道梗阻性病变的价值。结果 经手术病理检查确诊,70例患者中恶性病变30例(胰头癌12例,壶腹部癌14例,胆管癌4例),良性病变40例(胆道下段结石35例,胆管下段炎症梗阻5例);经Kappa一致性检验,多层螺旋CT 3D成像联合CT增强扫描检查诊断胆道梗阻性病变结果与手术病理结果的一致性极好(Kappa=0.800,P<0.001);多层螺旋CT 3D成像联合CT增强扫描检查敏感度、阴性预测值均高于层螺旋CT 3D成像、CT增强扫描单独检查,且准确度高于CT增强扫描,差异有统计学意义(P<0.05);多层螺旋CT 3D成像联合CT增强扫描检查壶腹部癌检出率高于多层螺旋CT 3D成像、CT增强扫描单独检查,差异有统计学意义(P<0.05)。结论 多层螺旋CT 3D成像联合增强扫描诊断胆道梗阻性病变的效果显著,且可明确其胆道梗阻性病变情况。

血清和胆汁CA19-9联合检测对诊断胆道良恶性病变的价值

目的 探讨CA19 9对胆道良恶性病变的诊断价值。方法 采用RIA联合检测经手术及病理证实的胆道恶性肿瘤 3 5例 ,胆道良性病变 92例及正常健康人 15例胆汁和血清中CA19 9及CEA水平。结果 血清CA19 9的敏感性、特异性分别为 80 .0 0 %和 85 .11% ,血清CEA的相应指标分别为 68.5 7%和 82 .97%。胆汁CA19 9含量的分界值为 12 0 0 0kU/L ,其敏感性、特异性分别为 85 .71%和 73 .91%。胆汁CEA水平分界值为 480 μg/L ,其相应指标分别为5 7.14 %和 77.17%。胆汁CA19 9及CEA含量的假阳性率分别为 2 6.0 9%和 2 2 .83 %。结论 CA19 9是诊断胆管癌是否被彻底切除 ,以及监测该病治疗反应有效的肿瘤标志物。

磁共振水成像在胰胆道系统病变中的应用

目的评价MR水成像在胰胆道系统病变中的临床应用。方法采用重T2加权MR水成像技术对66例患者行MRCP检查,图像经三维最大信号强度投影及三维表面遮蔽显示技术后处理。结果水成像定位率达100%,定性诊断率为86.6%,此技术可清楚显示胰胆管的形态,显示各种胆道疾病的异常改变,诊断符合高。结论MRCP对胆石症、恶性胆管梗阻及先天性胆总管囊肿等胆系疾病的诊断价值高于其他影像检查。

超声造影鉴别诊断胆囊良恶性病变Meta分析

目的应用Meta分析方法评价CEUS对胆囊病变的诊断价值。方法对Cochrane library、Pubmed数据库、Sciencedirect数据库、CNKI以及万方数据库中有关CEUS诊断胆囊占位性病变的中、英文文献进行筛选和评价,提取纳入研究的特征信息,通过Meta-disc1.4软件对入选文献的研究数据进行分析。结果共纳入16篇文献,包括中文12篇,英文4篇。CEUS诊断胆囊良恶性病变的合并诊断敏感度和特异度分别为90.9%（95%CI：87.5%~93.7%）、95.4%（95%CI：94.0%~96.5%）,合并阳性和阴性似然比分别为12.77（95%CI：8.46~19.27）、0.12（95%CI：0.09~0.18）,综合受试者工作特征曲线下面积为0.9695,Q＊指数0.9191。结论 CEUS对胆囊病变具有较高的诊断价值,可广泛应用于临床。