Biliary Cast in Non-Liver Transplantation: A Case Report with Literatures Review_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 張誠 ,  楊玉龍 , 吳萍 , 林美舉 , 張洪威 , 史力軍 , 李婧伊 , 張虎

大連大學附屬中山醫院膽道微創外科（遼寧大連 116001）;

Corresponding?author：

楊玉龍, Email: YYL516@126.com

Keywords：

膽管鑄型; 膽胰合流異常; 膽道鏡; 膽結石

DOI：

10.7507/1007-9424.20140180

Video：

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目的總結1例非肝移植膽管鑄型患者的診治過程。方法對1例非肝移植膽管鑄型患者的臨床資料、輔助檢查資料及治療效果進行分析，并進行文獻復習。結果 1例非肝移植膽管鑄型患者經生化檢查、膽胰管水成像（MRCP）、上腹部CT等檢查診斷為膽囊結石伴膽囊炎、膽總管結石伴低位膽管梗阻。采取開腹膽道探查、膽道鏡檢查取石、膽囊切除、T管引流手術治療。術中見膽囊縮小，與周圍大網膜膜性粘連，肝十二指腸韌帶水腫，膽總管擴張呈充盈狀態。膽道鏡下見肝內外膽管輕度擴張，肝外膽管壁炎性水腫較重，大量纖維素附著；膽總管末端通暢，可見胰管開口，進而診斷為膽胰合流異常。以膽道鏡從膽總管內取出1枚結石，約2.0 cm×1.5 cm×1.0 cm大，質硬，表面光滑；另取出1枚膽管鑄型，約3.5 cm×0.3 cm×0.3 cm大，質脆易碎，表面粗糙。該患者的手術順利，切除膽囊術后病理學檢查示慢性膽囊炎改變。術后恢復良好，未出現膽汁漏、出血等并發癥。術后隨訪1年，復查上腹部CT提示無結石復發，肝功能各項指標均正常。結論非肝移植膽管鑄型較少見，膽胰合流異常是非肝移植膽管鑄型和膽管結石形成的原因之一。膽道鏡是清除膽管鑄型和觀察膽管內結構的重要工具。

Citation： 張誠, 楊玉龍, 吳萍, 林美舉, 張洪威, 史力軍, 李婧伊, 張虎. Biliary Cast in Non-Liver Transplantation: A Case Report with Literatures Review. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(6): 757-760. doi: 10.7507/1007-9424.20140180 Copy

1.	?Starzl TE, Putnam CW, Hansbrough JF, et al.Biliary complications after liver transplantation:with special reference to the biliary cast syndrome and techniques of secondary duct repair[J].Surgery, 1977, 81(2):212-221.
2.	Zimmer V, Raedle J, Treiber G, et al.Biliary cast syndrome in sclerosing cholangitis[J].Dig Liver Dis, 2011, 43(2):e4.
3.	Gor NV, Levy RM, Ahn J, et al.Biliary cast syndrome following liver transplantation:predictive factors and clinical outcomes[J].Liver Transpl, 2008, 14(10):1466-1472.
4.	Parry SD, Muiesan P.Cholangiopathy and the biliary cast syndrome[J].Eur J Gastroenterol Hepatol, 2003, 15(4):341-343.
5.	Sheng R, Ramirez CB, Zajko AB, et al.Biliary stones and sludge in liver transplant patients:a 13-year experience[J].Radiology, 1996, 198(1):243-247.
6.	Waldram R, Williams R, Calne RY.Bile composition and bile cast formation after transplantation of the liver in man[J].Transplantation, 1975, 19(5):382-387.
7.	楊玉龍,付維利,劉小北,等.原位肝移植術后膽道結石的內鏡治療探討[J].中華消化內鏡雜志, 2005, 22(3):191-193.
8.	于強,楊玉龍,林美舉,等.經皮經肝膽道鏡治療肝移植術后膽管鑄型的安全性及其臨床價值觀察[J].中華消化內鏡雜志, 2011, 28(3):146-149.
9.	D'haens GR, Ruchim MA, Goldberg MJ, et al.Massive intrahepatic and extra-hepatic bile cast formation after cholecystectomy[J].Gastrointest Endosc, 1993, 39(4):579-581.
10.	Byrne MF, Chong HI, O'donovan D, et al.Idiopathic cholangiopathy in a biliary cast syndrome necessitating liver transplantation following head trauma[J].Eur J Gastroenterol Hepatol, 2003, 15(4):415-417.
11.	Gleeson FC, Czaja AJ, Baron TH.Successful endoscopic management of biliary cast syndrome in nonliver transplant patients[J].J Clin Gastroenterol, 2008, 42(6):752-755.
12.	Katsinelos P, Kountouras J, Chatzimavroudis G, et al.Combined endoscopic and ursodeoxycholic acid treatment of biliary cast syndrome in a non-transplant patient[J].World J Gastroenterol, 2008, 14(33):5223-5225.
13.	Dziurkowska-Marek A, Hartleb M, Marek TA, et al.Fatal case of biliary cast syndrome in nontransplant patient[J].Endoscopy, 2009, 41 Suppl 2:E256.
14.	Jain PA, Gandhi VV, Desai P, et al.Recurrent cholangitis in the tropics:worm or cast?[J].J Postgrad Med, 2010, 56(4):287-289.
15.	Kusnierz K, Nowakowska-Dulawa E, Pilch-Kowalczyk J, et al.Biliary cast syndrome in a non-transplant patient with acute pancreatitis[J].Dig Liver Dis, 2012, 44(6):534-535.
16.	Kinner S, Umutlu L, Dechêne A, et al.Biliary complications after liver transplantation:addition of T1-weighted images to MR cholangiopancreatography facilitates detection of cast in biliary cast syndrome[J].Radiology, 2012, 263(2):429-436.
17.	于強,楊玉龍,林美舉,等.肝移植術后膽管鑄型與肝膽管結石的形態學比較研究[J].中華外科雜志, 2011, 49(7):650-651.
18.	鐘明安,趙中辛.成人胰膽管合流異常患者膽囊黏膜病理形態觀察[J].肝膽胰外科雜志, 2007, 19(6):346-348.
19.	Williams NE, Gundara JS, Hugh TJ, et al.Many faces of pancreaticobiliary reflux[J].ANZ J Surg, 2012, 82(6):403-407.
20.	Kamisawa T, Honda G, Kurata M, et al.Pancreatobiliary disorders associated with pancreaticobiliary maljunction[J].Dig Surg, 2010, 27(2):100-104.
21.	Okada T, Sasaki F, Honda S, et al.Usefulness of axial planes of helical computed tomography for diagnosis of pancreaticobiliary maljunction in early infants with negative findings on magnetic resonance cholangiopancreatography[J].J Pediatr Surg, 2008, 43(3):579-582.
22.	Takuma K, Kamisawa T, Tabata T, et al.Importance of early diagnosis of pancreaticobiliary maljunction without biliary dilatation[J].World J Gastroenterol, 2012, 18(26):3409-3414.
23.	Kamisawa T, Takuma K, Itokawa F, et al.Endoscopic diagnosis of pancreaticobiliary maljunction[J].World J Gastrointest Endosc, 2011, 3(1):1-5.
24.	Saito T, Hishiki T, Terui K, et al.Use of preoperative, 3-dimensional magnetic resonance cholangiopancreatography in pediatric choledochal cysts[J].Surgery, 2011, 149(4):569-575.

1. ?Starzl TE, Putnam CW, Hansbrough JF, et al.Biliary complications after liver transplantation:with special reference to the biliary cast syndrome and techniques of secondary duct repair[J].Surgery, 1977, 81(2):212-221.
2. Zimmer V, Raedle J, Treiber G, et al.Biliary cast syndrome in sclerosing cholangitis[J].Dig Liver Dis, 2011, 43(2):e4.
3. Gor NV, Levy RM, Ahn J, et al.Biliary cast syndrome following liver transplantation:predictive factors and clinical outcomes[J].Liver Transpl, 2008, 14(10):1466-1472.
4. Parry SD, Muiesan P.Cholangiopathy and the biliary cast syndrome[J].Eur J Gastroenterol Hepatol, 2003, 15(4):341-343.
5. Sheng R, Ramirez CB, Zajko AB, et al.Biliary stones and sludge in liver transplant patients:a 13-year experience[J].Radiology, 1996, 198(1):243-247.
6. Waldram R, Williams R, Calne RY.Bile composition and bile cast formation after transplantation of the liver in man[J].Transplantation, 1975, 19(5):382-387.
7. 楊玉龍,付維利,劉小北,等.原位肝移植術后膽道結石的內鏡治療探討[J].中華消化內鏡雜志, 2005, 22(3):191-193.
8. 于強,楊玉龍,林美舉,等.經皮經肝膽道鏡治療肝移植術后膽管鑄型的安全性及其臨床價值觀察[J].中華消化內鏡雜志, 2011, 28(3):146-149.
9. D'haens GR, Ruchim MA, Goldberg MJ, et al.Massive intrahepatic and extra-hepatic bile cast formation after cholecystectomy[J].Gastrointest Endosc, 1993, 39(4):579-581.
10. Byrne MF, Chong HI, O'donovan D, et al.Idiopathic cholangiopathy in a biliary cast syndrome necessitating liver transplantation following head trauma[J].Eur J Gastroenterol Hepatol, 2003, 15(4):415-417.
11. Gleeson FC, Czaja AJ, Baron TH.Successful endoscopic management of biliary cast syndrome in nonliver transplant patients[J].J Clin Gastroenterol, 2008, 42(6):752-755.
12. Katsinelos P, Kountouras J, Chatzimavroudis G, et al.Combined endoscopic and ursodeoxycholic acid treatment of biliary cast syndrome in a non-transplant patient[J].World J Gastroenterol, 2008, 14(33):5223-5225.
13. Dziurkowska-Marek A, Hartleb M, Marek TA, et al.Fatal case of biliary cast syndrome in nontransplant patient[J].Endoscopy, 2009, 41 Suppl 2:E256.
14. Jain PA, Gandhi VV, Desai P, et al.Recurrent cholangitis in the tropics:worm or cast?[J].J Postgrad Med, 2010, 56(4):287-289.
15. Kusnierz K, Nowakowska-Dulawa E, Pilch-Kowalczyk J, et al.Biliary cast syndrome in a non-transplant patient with acute pancreatitis[J].Dig Liver Dis, 2012, 44(6):534-535.
16. Kinner S, Umutlu L, Dechêne A, et al.Biliary complications after liver transplantation:addition of T1-weighted images to MR cholangiopancreatography facilitates detection of cast in biliary cast syndrome[J].Radiology, 2012, 263(2):429-436.
17. 于強,楊玉龍,林美舉,等.肝移植術后膽管鑄型與肝膽管結石的形態學比較研究[J].中華外科雜志, 2011, 49(7):650-651.
18. 鐘明安,趙中辛.成人胰膽管合流異常患者膽囊黏膜病理形態觀察[J].肝膽胰外科雜志, 2007, 19(6):346-348.
19. Williams NE, Gundara JS, Hugh TJ, et al.Many faces of pancreaticobiliary reflux[J].ANZ J Surg, 2012, 82(6):403-407.
20. Kamisawa T, Honda G, Kurata M, et al.Pancreatobiliary disorders associated with pancreaticobiliary maljunction[J].Dig Surg, 2010, 27(2):100-104.
21. Okada T, Sasaki F, Honda S, et al.Usefulness of axial planes of helical computed tomography for diagnosis of pancreaticobiliary maljunction in early infants with negative findings on magnetic resonance cholangiopancreatography[J].J Pediatr Surg, 2008, 43(3):579-582.
22. Takuma K, Kamisawa T, Tabata T, et al.Importance of early diagnosis of pancreaticobiliary maljunction without biliary dilatation[J].World J Gastroenterol, 2012, 18(26):3409-3414.
23. Kamisawa T, Takuma K, Itokawa F, et al.Endoscopic diagnosis of pancreaticobiliary maljunction[J].World J Gastrointest Endosc, 2011, 3(1):1-5.
24. Saito T, Hishiki T, Terui K, et al.Use of preoperative, 3-dimensional magnetic resonance cholangiopancreatography in pediatric choledochal cysts[J].Surgery, 2011, 149(4):569-575.

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Biliary Cast in Non-Liver Transplantation: A Case Report with Literatures Review

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