经皮肝穿刺胆管引流术治疗儿童肝移植术后孤立性双胆肠吻合口狭窄

Percutaneous transhepatic cholangial drainage for treating isolated bilioenteric anastomotic stenosis after liver transplantation in children

目的观察经皮肝穿刺胆管引流术(PTCD)治疗儿童肝移植术后孤立性双胆肠吻合口狭窄(BAS)的有效性及安全性。方法回顾性分析31例于第2、3段胆管胆肠吻合口放置引流管以长期支撑的肝左叶外侧段移植术后BAS患儿,予以PTCD治疗,记录治疗后并发症、拔管成功率、治疗后血清总胆红素及是否接受二次肝移植。结果对31例均成功完成PTCD。1例PTCD后苏醒延迟,考虑为麻醉相关并发症,经对症治疗后好转。未见出血、感染及胆瘘等PTCD相关并发症。PTCD前血清总胆红素(64.09±24.40)μmol/L,治疗后首次复查血清总胆红素均正常、平均(19.98±3.99)μmol/L。对27例顺利拔除胆管引流管,成功率为87.10%(27/31),平均带管时间(7.0±3.7)个月;其余4例中,2例因间断发热仍需继续观察,2例因PTCD中发现部分胆管胆肠吻合口严重梗阻而拔除非梗阻段引流管并保留梗阻段引流管。31例均未接受二次肝移植术。结论PTCD治疗儿童肝移植术后BAS有效且安全。

Objective To observe the efficacy and safety of percutaneous transhepatic cholangial drainage(PTCD)for treating isolated bilioenteric anastomotic stenosis(BAS)after liver transplantation in children.Methods Totally 31 children with BAS after liver transplantation were retrospectively enrolled.PTCD was performed,and the drainage tubes were placed into bilioenteric anastomosis of the second and the third biliary tract for long-term support.Complications after PTCD,success rate of extubation,serum total bilirubin after PTCD and performance of the secondary liver transplantation or not were recorded.Results All 31 cases were successfully treated with PTCD.Delayed recovery after general anesthesia occurred in 1 case after PTCD,which was considered as anesthesia related complication and relieved after symptomatic treatments.No PTCD related complication,such as hemorrhage,infection and biliary fistula occurred.The serum total bilirubin before PTCD was(64.09±24.40)μmol/L,which returned to normal at the first reexamined after treatment with an average of(19.98±3.99)μmol/L.The drainage tubes were successfully extubated in 27 cases,with the success rate of 87.10%(27/31)and the mean drainage time of(7.0±3.7)months.Among the rest 4 cases,further observation was necessary in 2 cases due to intermittent fever,while severe obstruction of bilioenteric anastomosis was found during PTCD,the drainage tube of non-obstruction segment was removed but of obstruction segment was retained in the other 2 cases.No secondary liver transplantation was performed.Conclusion PTCD was effective and safe for treating BAS after liver transplantation in children.