Sacchetto P, Veltri A, Cena V, Gisolo F, Gennari F, Salizzoni M, Righi D, Gandini G
Istituto di Radiologia, Università di Torino, Via Genova 3, I-10126 Turin, Italy.
Radiol Med. 2007 Apr;112(3):456-71. doi: 10.1007/s11547-007-0128-6. Epub 2007 Apr 20.
The aim of our study was to evaluate the radiologist's role in managing paediatric orthotopic liver transplantation (OLT) through a retrospective review of our experience in diagnosing and treating post-OLT complications.
Forty children (mean age 4.6 years) underwent 44 OLTs over 71 months. The follow-up period (mean 724 days) was divided into three phases: hospital stay, up to three months after discharge and subsequent period. The number and type of radiological examinations, radiologically detectable complications and interventional procedures were analysed.
Most examinations were carried out with ultrasound (US) (859/931 of all radiological studies performed during the first two phases, 92.3%). Colour-Doppler US enabled early detection and treatment of all vascular complications (9/40, 22.5% of patients; 13 complications in nine patients, eight arterial and five portal complications; 1.4 for each patient with complications). Computed tomography (CT) or angiography was very rarely employed. US also detected biliary complications (11 patients, 27.5%: three cases of segmental ducts excluded from the anastomosis, four cases of stenosis of the biliodigestive anastomosis, one lithiasis, three stenoses associated with lithiasis), which were successfully managed in 75% of the cases treated with interventional radiology procedures (percutaneous bilioplasty and/or lithotripsy). At the time of writing this paper, the patient survival rate was 100%, and the organ survival rate was 91% (40/44). There were four re-transplantations: three due to hepatic artery thrombosis and one to biliary stenosis with lithiasis.
The radiologist's role is fundamental for early sonographic diagnosis of post-OLT complications in children. Vascular complications are often associated in a single patient, and early treatment may improve the prognosis. Interventional radiology represents a safe and effective treatment for many biliary complications.
本研究旨在通过回顾我们在诊断和治疗小儿原位肝移植（OLT）术后并发症方面的经验，评估放射科医生在小儿OLT管理中的作用。
40名儿童（平均年龄4.6岁）在71个月内接受了44例OLT。随访期（平均724天）分为三个阶段：住院期间、出院后至三个月以及随后的时期。分析了放射学检查的数量和类型、放射学可检测到的并发症以及介入程序。
大多数检查采用超声（US）（在前两个阶段进行的所有放射学研究中，859/931，92.3%）。彩色多普勒超声能够早期发现并治疗所有血管并发症（9/40，22.5%的患者；9名患者出现13处并发症，8处动脉并发症和5处门静脉并发症；每位有并发症的患者平均1.4处）。计算机断层扫描（CT）或血管造影很少使用。超声还检测到胆系并发症（11例患者，27.5%：3例节段性胆管未纳入吻合，4例胆肠吻合口狭窄，1例结石，3例伴有结石的狭窄），其中75%接受介入放射学程序（经皮胆管成形术和/或碎石术）治疗的病例成功得到处理。在撰写本文时，患者生存率为100%，器官生存率为91%（40/44）。有4例再次移植：3例因肝动脉血栓形成，1例因胆系狭窄合并结石。
放射科医生的作用对于小儿OLT术后并发症的早期超声诊断至关重要。血管并发症常出现在同一患者身上，早期治疗可能改善预后。介入放射学是治疗许多胆系并发症的安全有效的方法。
