Kulkarni Chinmay B, Prabhu Nirmal K, Kader Nazar P, Rajeshkannan Ramiah, Pullara Sreekumar K, Moorthy Srikanth
Department of Radiology, Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala, India.
Indian J Radiol Imaging. 2017 Jan-Mar;27(1):92-99. doi: 10.4103/0971-3026.202950.
To retrospectively analyze the percutaneous transhepatic techniques and their outcome in the management of biliary strictures in living donor liver transplant (LDLT) recipients.
We retrieved the hospital records of 400 LDLT recipients between 2007 and 2015 and identified 45 patients with biliary strictures. Among them, 17 patients (37.8%) (Male: female = 13:4; mean age, 36.1 ± 17.5 years) treated by various percutaneous transhepatic biliary techniques alone or in combination with endoscopic retrograde cholangiopancreatography (ERCP) were included in the study. The technical and clinical success of the percutaneous management was analyzed.
Anastomotic strictures associated with leak were found in 12/17 patients (70.6%). Ten out of 12 (83.3%) patients associated with leak had more than one duct-duct anastomoses (range, 2-3). The average duration of onset of stricture in patients with biliary leak was 3.97 ± 2.68 months and in patients with only strictures it was 14.03 ± 13.9 months. In 6 patients, endoscopic-guided plastic stents were placed using rendezvous technique, plastic stent was placed from a percutaneous approach in 1 patient, metallic stents were used in 2 patients, cholangioplasty was performed in 1 patient, N-butyl- 2-cyanoacrylate embolization was done in 1 child with biliary-pleural fistula, internal-external drain was placed in 1 patient, and only external drain was placed in 5 patients. Technical success was achieved in 12/17 (70.6%) and clinical success was achieved in 13/17 (76.5%) of the patients. Posttreatment mean time of follow-up was 19.4 ± 13.7 months. Five patients (29.4%) died (two acute rejections, one metabolic acidosis, and two sepsis).
Percutaneous biliary techniques are effective treatment options with good outcome in LDLT patients with biliary complications.
回顾性分析经皮肝穿刺技术及其在活体肝移植（LDLT）受者胆管狭窄治疗中的效果。
我们检索了2007年至2015年间400例LDLT受者的医院记录，确定了45例胆管狭窄患者。其中，17例患者（37.8%）（男∶女 = 13∶4；平均年龄，36.1±17.5岁）单独采用各种经皮肝穿刺胆管技术或联合内镜逆行胰胆管造影（ERCP）进行治疗，并纳入本研究。分析经皮治疗的技术成功率和临床成功率。
17例患者中有12例（70.6%）发现与渗漏相关的吻合口狭窄。12例与渗漏相关的患者中有10例（83.3%）有不止一处胆管 - 胆管吻合（范围为2 - 3处）。胆管渗漏患者狭窄开始的平均时间为3.97±2.68个月，仅存在狭窄的患者为14.03±13.9个月。6例患者采用会师技术在内镜引导下放置塑料支架，1例患者经皮途径放置塑料支架，2例患者使用金属支架，1例患者进行胆管成形术，1例胆 - 胸膜瘘患儿进行氰基丙烯酸正丁酯栓塞，1例患者放置内外引流管，5例患者仅放置外引流管。17例患者中有12例（70.6%）技术成功，13例（76.5%）临床成功。治疗后平均随访时间为19.4±13.7个月。5例患者（29.4%）死亡（2例急性排斥反应，1例代谢性酸中毒，2例脓毒症）。
经皮胆管技术是治疗LDLT合并胆管并发症患者的有效选择，效果良好。
