Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
Department of Pediatrics, Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA.
Pediatr Transplant. 2021 Sep;25(6):e14028. doi: 10.1111/petr.14028. Epub 2021 May 5.
To evaluate the efficacy of percutaneous and endoscopic therapeutic interventions for biliary strictures and leaks following LT in children.
Retrospective analysis of 49 consecutive pediatric liver transplant recipients (27 girls, 22 boys, mean age at transplant 3.9 years) treated at our institution from 1989 to 2019 for biliary leak and/or biliary stricture was performed. Minimally invasive approach was considered clinically successful if it resulted in patency of the narrowed biliary segment and/or correction of the biliary leak.
Forty-two patients had a stricture at the biliary anastomosis; seven had a biliary leak. After an average 13.8 years of follow-up, long-term clinical success with minimally invasive treatment (no surgery or re-transplant) was achieved for 24 children (57%) with biliary stricture and 4 (57%) with biliary leaks. Eight patients required re-transplant; however, only one was due to failure of both percutaneous and surgical management. For biliary strictures, failure of non-surgical management was associated with younger age at stricture diagnosis (p < .02).
Percutaneous and endoscopic management of biliary strictures and leaks after LT in children is associated with a durable result in >50% of children.
评估经皮和内镜治疗小儿肝移植后胆道狭窄和漏的疗效。
对 1989 年至 2019 年在我院接受治疗的 49 例小儿肝移植后（27 例女性，22 例男性，移植时平均年龄 3.9 岁）胆道漏和/或胆道狭窄的连续患儿进行回顾性分析。如果狭窄的胆道段通畅和/或胆道漏得到纠正，则微创方法被认为具有临床疗效。
42 例患儿存在胆肠吻合口狭窄，7 例患儿存在胆漏。平均随访 13.8 年后，24 例（57%）胆道狭窄和 4 例（57%）胆漏患儿经微创治疗（无手术或再次肝移植）获得长期临床成功。8 例患儿需要再次肝移植；然而，只有 1 例是由于经皮和手术治疗均失败。对于胆道狭窄，非手术治疗失败与狭窄诊断时年龄较小有关（p <.02）。
经皮和内镜治疗小儿肝移植后胆道狭窄和漏的方法在超过 50%的患儿中具有持久的效果。
