Lauterio Andrea, Slim Abdallah, Aseni Paolo, Giacomoni Alessandro, Di Sandro Stefano, Corso Rocco, Mangoni Iacopo, Mihaylov Plamen, Al Kofahi Mohammed, Pirotta Vincenzo, De Carlis Luciano
Division of General Surgery and Abdominal Organ Transplantation, Niguarda Hospital, 20162 Milan, Italy.
J Transplant. 2009;2009:824803. doi: 10.1155/2009/824803. Epub 2009 Jun 24.
Biliary complications continue to be a major cause of morbidity after split-liver transplantation (SLT). In this report we describe an uncommon late biliary complication. One year after SLT the patient showed an intrahepatic bile dicy dilatation with severe cholangitis episodes. The segmentary bile duct of hepatic segment VI-VII draining in the left duct was unidentified and tied at the time of the in situ split-liver procedure. We perform a permanent obliteration of the dilated intrahepatic ducts by a percutaneous embolization using an n-butyl cyanoacrylate (NABC). The management of biliary complications after SLT requires a multidisciplinary approach. The use of NBCA in obliteration of a dilated bile duct seems to be a safe procedure with good results providing a less invasive option than hepatic resection and decreasing the morbidity associated with chronic external biliary drainage. Further studies are needed to determine whether this approach is effective and safe and whether it could reduce hospital stay and cost.
胆道并发症仍然是活体肝移植（SLT）后发病的主要原因。在本报告中，我们描述了一种罕见的晚期胆道并发症。活体肝移植术后一年，患者出现肝内胆管双扩张并伴有严重胆管炎发作。引流至左肝管的肝段VI-VII的节段性胆管在原位活体肝手术时未被识别并结扎。我们使用正丁基氰基丙烯酸酯（NABC）通过经皮栓塞术对扩张的肝内胆管进行永久性闭塞。活体肝移植术后胆道并发症的处理需要多学科方法。使用NBCA闭塞扩张胆管似乎是一种安全的手术，效果良好，与肝切除术相比侵入性较小，并降低了与慢性外引流相关的发病率。需要进一步研究以确定这种方法是否有效和安全，以及是否可以缩短住院时间和降低成本。
