儿童亲体肝移植术后膈疝的诊断与治疗

Acquired diaphragmatic hernia in pediatrics after living donor liver transplantation

目的探讨儿童亲体肝移植术后膈疝的诊断和治疗。方法4例患者术前原发病均为胆道闭锁,移植时月龄5~7个月,移植物均为肝脏左外叶,发生膈疝的时间为术后1.5~16个月,包括右侧膈疝3例、左侧膈疝1例。结果4例患者的移植物质量及移植物质量与受者体质量比分别为170g,170g、210g、290g与2.7%、2.5%、3%、5%。4例患者临床表现主要表现为急性呼吸抑制、消化不良或肠梗阻。4例患者均通过CT或X光片确诊,行开腹手术修补膈疝,其中3例行急诊手术。疝内容物为部分小肠及部分结肠,其中1例存在远端胃进入右侧胸腔。4例患者膈疝修补术后呼吸及消化功能恢复正常,无并发症出现。结论膈疝为亲体肝移植术后少见的并发症,主要见于以肝脏左外叶为移植物的儿童肝移植受者,诊断明确后应及早手术治疗。

Objective To explore the diagnosis and treatment of diaphragmatic hernia (DH) secondary to living donor liver transplantation (LDLT)in pediatrics.Methods The primary disease was biliary atresia and all of the 4patients underwent LDLT using a donor's left lateral graft.The ages of recipients were 5-7 months at LDLT and the onset of DH were 1.5-16 months after LDLT.There were 3 right DH and 1left DH,and 3 were emergency cases.Results The graft weight and graft to recipient body weight ratio (GRWR)were respectively between 170-290 g and between 2.7%-5.0%.Clinical symptoms included urgent respiratory distress,dyspepsia or gastrointestinal obstruction.DH was diagnosed by computed tomography scan or X-ray of the chest.Laparotomy were performed successfully to repair the DH including emergency laparotomy in three patients.Herniated organs were partial intestines or colon and partial stomach.All cases recovered without major complications.Conclusions DH post-LDLT is an unusual complication,often calls for emergent management.