Karakayalı F, Kırnap M, Akdur A, Tutar N, Boyvat F, Moray G, Haberal M
Department of General Surgery, Baskent University Faculty of Medicine, Ankara, Turkey.
Transplant Proc. 2013;45(10):3524-7. doi: 10.1016/j.transproceed.2013.09.012.
After liver transplantation, biliary complications are more prevalent in pediatric patients, with reported rates varying between 15% and 30%.
We retrospectively analyzed biliary complications observed in 84 pediatric liver transplantation patients between July 2006 and September 2012. Biliary reconstruction was accomplished via a duct-to-duct anastomosis in 5 (83.3%) of the 6 patients receiving whole liver grafts and in 44 (56.4%) of the 78 patients who received a segmental live donor graft. For the remaining 34 patients with living donor and 1 patient with whole liver graft, Roux-en-Y hepaticojejunostomy was the preferred method.
Post-transplantation biliary complications were encountered in 26 patients (30.1%). The biliary complication rate was 38% in 49 duct-to-duct anastomosis, whereas it was 20% in the hepaticojejunostomy group consisting of 35 recipients. Thirteen of the 18 biliary leaks were from duct-to-duct anastomoses and the remaining 5 were from the hepaticojejunostomies and 6 of the 8 biliary strictures were observed in recipients with duct-to-duct anastomosis. In 19 of the 26 patients, the biliary complications were successfully treated with interventional radiologic procedures and 1 was treated with stent placement during endoscopic retrograde cholangiopancreatography.
Percutaneous interventional procedures are valuable, effective, and life-saving therapeutic alternatives for the treatment of bile leaks and strictures after pediatric liver transplantations.
肝移植术后，小儿患者的胆道并发症更为常见，报道的发生率在15%至30%之间。
我们回顾性分析了2006年7月至2012年9月期间84例小儿肝移植患者中观察到的胆道并发症。6例接受全肝移植的患者中有5例（83.3%）通过胆管对胆管吻合完成胆道重建，78例接受活体供肝节段性移植的患者中有44例（56.4%）如此。其余34例活体供肝患者和1例全肝移植患者中，Roux-en-Y肝空肠吻合术是首选方法。
26例患者（30.1%）出现移植后胆道并发症。49例胆管对胆管吻合患者的胆道并发症发生率为38%，而由35例受者组成的肝空肠吻合术组的发生率为20%。18例胆漏中有13例来自胆管对胆管吻合，其余5例来自肝空肠吻合，8例胆管狭窄中有6例见于胆管对胆管吻合的受者。26例患者中有19例的胆道并发症通过介入放射学方法成功治疗，1例在内镜逆行胰胆管造影期间通过放置支架治疗。
经皮介入程序是治疗小儿肝移植术后胆漏和狭窄的有价值、有效的且挽救生命的治疗选择。
