Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany.
Department of Radiology, University of Regensburg, University Medical Center Regensburg, 93053 Regensburg, Germany.
Tomography. 2023 Oct 19;9(5):1965-1975. doi: 10.3390/tomography9050153.
Biliary leaks are a severe complication after pediatric liver transplantation (pLT), and successful management is challenging.
The aim of this case series was to assess the outcome of percutaneous transhepatic biliary drainage (PTBD) in children with bile leaks following pLT. The necessity of additional percutaneous bilioma drainage and laboratory changes during therapy and follow-up was documented.
All children who underwent PTBD for biliary leak following pLT were included in this consecutive retrospective single-center study and analyzed regarding site of leak, management of additional bilioma, treatment response, and patient and transplant survival. The courses of inflammation, cholestasis parameters, and liver enzymes were retrospectively reviewed.
Ten children underwent PTBD treatment for biliary leak after pLT. Seven patients presented with leakage at the hepaticojejunostomy, two with leakage at the choledocho-choledochostomy and one with a bile leak because of an overlooked segmental bile duct. In terms of the mean, the PTBD treatment started 40.3 ± 31.7 days after pLT. The mean duration of PTBD treatment was 109.7 ± 103.6 days. Additional percutaneous bilioma drainage was required in eight cases. Bile leak treatment was successful in all cases, and no complications occurred. The patient and transplant survival rate was 100%. CRP serum level, leukocyte count, gamma-glutamyl transferase (GGT), and total and direct bilirubin level decreased significantly during treatment with a very strong effect size. Additionally, the gamma-glutamyl transferase level showed a statistically significant reduction during follow-up.
PTBD is a very successful strategy for bile leak therapy after pLT.
胆漏是小儿肝移植（pLT）后的严重并发症，其成功管理具有挑战性。
本病例系列旨在评估经皮经肝胆管引流（PTBD）在 pLT 后胆漏患儿中的应用效果。记录了治疗过程中和随访期间需要进行额外的经皮胆汁瘤引流和实验室检查的情况。
本连续回顾性单中心研究纳入了所有因 pLT 后胆漏而行 PTBD 的患儿，分析了漏口部位、额外胆汁瘤的处理、治疗反应以及患者和移植的存活率。回顾性分析了炎症、胆汁淤积参数和肝酶的变化过程。
10 例患儿因 pLT 后胆漏而行 PTBD 治疗。7 例患者的漏口位于胆肠吻合口，2 例位于胆肠吻合口，1 例漏口位于被忽视的肝段胆管。PTBD 治疗平均在 pLT 后 40.3±31.7 天开始。PTBD 治疗的平均时间为 109.7±103.6 天。8 例患儿需要进行额外的经皮胆汁瘤引流。所有病例的胆漏治疗均取得成功，无并发症发生。患者和移植的存活率为 100%。在治疗过程中，C 反应蛋白（CRP）血清水平、白细胞计数、γ-谷氨酰转移酶（GGT）以及总胆红素和直接胆红素水平显著下降，且效应量非常大。此外，GGT 水平在随访期间也呈现统计学意义的降低。
PTBD 是 pLT 后胆漏治疗的一种非常成功的策略。
