Lorenz J M, Funaki B, Leef J A, Rosenblum J D, Van Ha T
Department of Radiology, The University of Chicago Hospitals, 5841 S. Maryland Ave., MC 2026, Chicago, IL 60637, USA.
AJR Am J Roentgenol. 2001 Mar;176(3):761-5. doi: 10.2214/ajr.176.3.1760761.
In children with liver transplants, percutaneous transhepatic cholangiography has a critical role in evaluation and treatment of biliary complications. The purpose of this study was to evaluate the technical success and complication rates of percutaneous transhepatic cholangiography and biliary drain placement in children who underwent liver transplantation.
Between January 1, 1995 and July 1, 1999, 120 pediatric percutaneous transhepatic cholangiography procedures were performed in 76 patients (34 boys, 42 girls; age range, 5 months to 18 years; mean age, 5.3 years). Patients had received left lateral segment, whole-liver, or split-liver transplant grafts. Retrospective review of all pertinent radiology studies and electronic chart review were performed.
A diagnostic cholangiogram was obtained in 96% (115/120) of all procedures and drainage catheter placement was successful in 89% (88/99) of attempts. In patients with nondilated intrahepatic bile ducts, a diagnostic cholangiogram was obtained in 92% (46/50) of procedures, and drainage catheter placement was successful in 76% (19/25) of attempts. Minor complications occurred in 10.8% (13/120) of procedures and included transient hemobilia with mild drop in hematocrit level (n = 2), mild pancreatitis (n = 1), fever with bacteremia (n = 5), and fever with negative blood cultures (n = 5). Major complications occurred in 1.7% (2/120) of procedures and included sepsis (n = 1) and hemoperitoneum requiring immediate surgery (n = 1).
Percutaneous transhepatic cholangiography and biliary drainage can be performed with high technical success and low complication rates in pediatric liver transplant patients, even in those with nondilated intrahepatic ducts.
在接受肝移植的儿童中，经皮肝穿刺胆管造影术在胆道并发症的评估和治疗中起着关键作用。本研究的目的是评估接受肝移植儿童经皮肝穿刺胆管造影术及胆管引流管置入术的技术成功率和并发症发生率。
1995年1月1日至1999年7月1日期间，对76例患者（34例男孩，42例女孩；年龄范围5个月至18岁；平均年龄5.3岁）进行了120例儿童经皮肝穿刺胆管造影术。患者接受了左外侧叶、全肝或劈离式肝移植。对所有相关放射学研究进行回顾性分析，并查阅电子病历。
所有操作中96%（115/120）获得了诊断性胆管造影，引流导管置入成功率为89%（88/99）。在肝内胆管未扩张的患者中，92%（46/50）的操作获得了诊断性胆管造影，引流导管置入成功率为76%（19/25）。10.8%（13/120）的操作出现轻微并发症，包括短暂性胆道出血伴血细胞比容水平轻度下降（n = 2）、轻度胰腺炎（n = 1）、发热伴菌血症（n = 5）和发热伴血培养阴性（n = 5）。1.7%（2/120）的操作出现严重并发症，包括脓毒症（n = 1）和需要立即手术的腹腔积血（n = 1）。
在儿童肝移植患者中，即使是肝内胆管未扩张的患者，经皮肝穿刺胆管造影术和胆管引流术也能获得较高的技术成功率和较低的并发症发生率。
