Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 14021, Prague 4, Czech Republic.
Department of Pediatric and Trauma Surgery Third Faculty of Medicine, Charles University, Thomayer Teaching Hospital, Vídeňská 800, 14059, Prague 4, Czech Republic.
Cardiovasc Intervent Radiol. 2020 May;43(5):765-774. doi: 10.1007/s00270-020-02430-8. Epub 2020 Feb 10.
To assess the efficacy of percutaneous techniques in managing paediatric liver transplantation complications.
We carried out 105 paediatric cadaveric donor liver transplantations at our centre from 2001 to 2018. Percutaneous techniques were used to treat 25 cases involving transplantation complications in 23 patients. Biliary complications were treated in 14 cases (13.3%): 10 patients had bile duct obstruction, and 4 had biliary leaks. Vascular complications were treated in 11 cases (10.5%): 5 hepatic artery (HA) stenoses/occlusions, 2 inferior vena cava (IVC) stenoses, and 1 portal vein (PV) stenosis. Other interventions involved embolisation of the superior mesenteric artery branch to manage gastrointestinal bleeding in 2 patients and embolisation of an arteriobiliary fistula in 1 patient.
Biliary: We carried out external-internal drainage and balloon dilatation of stenoses in 12 cases. The external-internal drainage catheter was removed after 6-8 weeks in 7 patients, with the remaining 5 patients with persisting stenosis assigned for retransplantation. We failed to cross anastomotic occlusions in 2 patients before completing the procedures using external drainage; both individuals subsequently underwent retransplantation. Vascular: We performed PTA/stenting of HA stenoses/occlusions in 4 out of 5 patients. After the procedure, all 4 patients showed liver function normalisation. All 3 cases of embolisation were technically and clinically successful. Both IVC and PV stenoses treated with dilatation/stenting were also successful.
Percutaneous techniques used to treat biliary and vascular complications after liver transplantation in paediatric patients are safe and efficient.
评估经皮技术在处理小儿肝移植并发症中的疗效。
本中心 2001 年至 2018 年共进行了 105 例小儿尸体供肝移植。采用经皮技术治疗 23 例 25 例移植并发症患者。胆道并发症治疗 14 例（13.3%）：10 例胆管梗阻，4 例胆漏。血管并发症治疗 11 例（10.5%）：5 例肝动脉（HA）狭窄/闭塞，2 例下腔静脉（IVC）狭窄，1 例门静脉（PV）狭窄。其他干预措施包括栓塞肠系膜上动脉分支以治疗 2 例胃肠道出血，栓塞 1 例动静脉瘘。
胆道：12 例进行了内外引流和狭窄球囊扩张。7 例患者在 6-8 周后拔除内外引流管，5 例持续狭窄患者再移植。2 例患者在完成外引流前未能通过吻合口闭塞，均进行了再移植。HA 狭窄/闭塞行 PTA/支架置入术 4 例。术后 4 例患者肝功能均恢复正常。3 例栓塞均为技术和临床成功。经扩张/支架治疗的 2 例 IVC 和 1 例 PV 狭窄均成功。
经皮技术治疗小儿肝移植后胆道和血管并发症安全有效。
