经皮经肝胆道引流治疗儿童肝移植后胆道狭窄的长期疗效。

Long-term outcome of percutaneous transhepatic biliary drainage for biliary strictures following pediatric liver transplantation.

机构信息

Department of Transplant Surgery, Jichi Medical University, Shimotsuke, Japan.

Department of Surgery, Haga Red Cross Hospital, Mooka, Japan.

出版信息

Clin Transplant. 2019 Jun;33(6):e13570. doi: 10.1111/ctr.13570. Epub 2019 May 23.

DOI:10.1111/ctr.13570

PMID:31006158

Abstract

BACKGROUND

We present a retrospective analysis of our experience with pediatric liver transplantation (LT), focusing on the long-term outcome of percutaneous transhepatic biliary drainage (PTBD) for post-transplant biliary strictures.

METHODS

Fifty-three PTBDs were performed for 41 pediatric recipients with biliary strictures. The median ages at LT and PTBD were 1.4 and 4.4 years, respectively. The median observation period was 10.6 years.

RESULTS

Post-transplant biliary strictures comprised anastomotic stricture (AS) in 28 cases, nonanastomotic stricture (NAS) in 12, anastomotic obstruction (AO) in 8, and nonanastomotic obstruction (NAO) in 5. The success rate of PTBD was 90.6%, and the 15-year primary patency rate of PTBD was 52.6%. The recurrence rate of biliary strictures after PTBD was 18.8% (9/48), and among the four NAS cases with recurrence, two underwent re-LT. The biliary obstruction rate was 27.1% (13/48). Among the eight cases with AO, five underwent the rendezvous method and three underwent surgical re-anastomosis. Among the five cases with NAO, one underwent re-LT. The recipient survival rate of PTBD treatment was 100%.

CONCLUSIONS

The graft prognosis of AS by PTBD treatment is good and AO is curable by the rendezvous method and surgical re-anastomosis. However, the graft prognosis of NAS and NAO is poor.

摘要

背景

我们回顾性分析了我们在小儿肝移植（LT）方面的经验，重点关注经皮经肝胆道引流（PTBD）治疗移植后胆道狭窄的长期结果。

方法

41 例胆道狭窄患儿共进行了 53 次 PTBD。LT 和 PTBD 的中位年龄分别为 1.4 岁和 4.4 岁。中位观察期为 10.6 年。

结果

移植后胆道狭窄包括吻合口狭窄（AS）28 例、非吻合口狭窄（NAS）12 例、吻合口梗阻（AO）8 例和非吻合口梗阻（NAO）5 例。PTBD 的成功率为 90.6%，PTBD 的 15 年原发性通畅率为 52.6%。PTBD 后胆道狭窄的复发率为 18.8%（9/48），4 例 NAS 复发患者中有 2 例再次接受 LT。胆道梗阻发生率为 27.1%（13/48）。8 例 AO 中有 5 例行会师法，3 例行再次吻合术。5 例 NAO 中有 1 例再次接受 LT。PTBD 治疗的受者存活率为 100%。