Feier Flávia H, Chapchap Paulo, Pugliese Renata, da Fonseca Eduardo A, Carnevale Francisco C, Moreira Airton M, Zurstrassen Charles, Santos Aline C, Miura Irene K, Baggio Vera, Porta Adriana, Guimarães Teresa, Cândido Helry, Benavides Marcel, Godoy Andre, Leite Katia M R, Porta Gilda, Kondo Mario, Seda-Neto João
Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil; Hepatology and Liver Transplantation, Sírio Libanês Hospital, São Paulo, Brazil.
Liver Transpl. 2014 Aug;20(8):882-92. doi: 10.1002/lt.23896.
The incidence of biliary complications (BCs) after living donor liver transplantation (LDLT) can reach 40%. Published data on the pediatric population are limited, and treatment protocols vary. Our aim was to describe the clinical scenario for BCs and treatment approaches after LDLT. Between October 1995 and December 2012, 489 pediatric LDLT procedures were performed. BCs developed in 71 patients (14.5%). Biliary strictures (BSs) developed in 45 (9.2%) patients, and bile leaks (BLs) developed in 33 patients (6.7%). The BL diagnosis was clinical in all cases, and 69.7% of the patients underwent surgery. Nearly half of the BS cases had clinical features or suggestive ultrasound findings. Liver biopsy findings suggested BSs in 51.7%. Percutaneous transhepatic cholangiography was performed in 95.6% of the BS patients. The success rate was 77% [mean number of percutaneous biliary interventions (PBIs) = 3.9 ± 1.98, median drainage time = 8 months]. In conclusion, BL patients can be managed with conservative therapy, even though most of these patients will ultimately be treated with surgery. Diagnosing a BS requires a high degree of clinical suspicion because the available resources for its identification can fail in up to 50% of cases. A higher number of PBIs and the use of a drainage catheter for a longer time may be required to achieve better results with this technique.
活体肝移植（LDLT）后胆道并发症（BCs）的发生率可达40%。关于儿科人群的已发表数据有限，且治疗方案各不相同。我们的目的是描述LDLT后BCs的临床情况及治疗方法。1995年10月至2012年12月期间，共进行了489例儿科LDLT手术。71例患者（14.5%）发生了BCs。45例（9.2%）患者出现了胆管狭窄（BSs），33例患者（6.7%）出现了胆漏（BLs）。所有病例的BL诊断均基于临床，69.7%的患者接受了手术。近一半的BS病例具有临床特征或超声检查有提示性发现。肝活检结果提示BSs的占51.7%。95.6%的BS患者接受了经皮肝穿刺胆管造影。成功率为77%[经皮胆道介入（PBI）的平均次数=3.9±1.98，中位引流时间=8个月]。总之，BL患者可采用保守治疗，尽管这些患者中的大多数最终将接受手术治疗。诊断BS需要高度的临床怀疑，因为用于识别它的现有方法在高达50%的病例中可能会失败。使用该技术可能需要更多次数的PBI以及更长时间地使用引流导管才能取得更好的效果。
