Peng Yuming,Si Zhongzhou,Yuan Miaoxian,et al.Diagnoses and treatments of hepatic transplantation in 20 children[J].Journal of Clinical Pediatric Surgery,,18():681-685.[doi:10.3969/j.issn.1671-6353.2019.08.013]
Diagnoses and treatments of hepatic transplantation in 20 children
- Keywords:
- Liver Transplantion; Biliary Atresia/SU; Liver Cirrhosis/SU; Indications; Postoperative Complications; Child
- CLC:
- R617;R657.3;R657.4+4;R619
- Abstract:
- Objective To explore the clinical efficacies and treatments of 20 pediatric cases of hepatic transplantation.Methods From May 2017 to June 2019,retrospective analysis was performed for the clinical data of 20 cases of pediatric hepatic transplantation at Hunan Children’s Hospital and Second Xiangya Hospital,Central South University.The primary diseases included biliary atresia,Alagille syndrome and congenital intrahepatic cavernous transformation of portal vein.The surgical approaches were parental partial hepatic transplantation (n=16) and DCD hepatic transplantation (n=4).Tacrolimus plus hormonal immunosuppression were applied and three cases received additional mycophenolate mofetil.Antibiotic agents and anti-rejection supports were employed postoperatively.Blood flow in the anastomosis of hepatic vessels,liver function alterations,postoperative complications and prognosis were recorded.Results All recipients were successfully operated and all donors had no complications.The early major complications of recipients was predominantly bacterial infection and the infection sites included lung and abdominal cavity.The postoperative complications were hepatoarterial embolization (n=1),chylous fistula (n=3),biliary stricture (n=2),early rejection (n=3) and massive hemorrhage of gastrointestinal tract (n=1).After symptomatic treatments,all recipients recovered and were discharged.Both liver function and blood drug concentrations were within normal ranges.Conclusion Advanced liver disease in children may be ideally treated by living or DCD hepatic transplantation.And surgical approach is selected on the basis of age and body weight.
References:
1 李威,沈中阳.我国儿童肝移植的现状与展望[J].外科理论与实践,2014,19(4):292-295.DOI:10.3969/j.issn.1007-9610.2014.04.005.Li W,Shen ZY.Current status and future perspectives of pediatric hepatic transplantation in China[J].J Sur Concepts Pract,2014,19(4):292-295.DOI:10.3969/j.issn.1007-9610.2014.04.005.
2 De Freitas Paganoti G,Tannuri A,Dantas Marques AC,et al. Extensive hepatectomy as an alternative to liver transplant in advanced hepatoblastoma:a new protocol used in a pediatric liver transplantation center[J]. Transplant Proc,2019,51(5):1605-1610.DOI:10.1016/j.transproceed.2019.03.004.
3 Gao W,Song Z,Ma N,et al. Utility of neonatal donors in pediatric liver transplantation:A single-center experience[J]. Pediatr Ttansplant,2019,23(5):13396.DOI:10.1111/petr.13396.
4 夏强.中国儿童肝移植临床诊疗指南(2015版)[J].中华移植杂志(电子版),2016(1):2-11.DOI:10.3969/j.issn.1001-5256.2016.07.001.Xia Q.Clinical guidelines for pediatric liver transplantation in China (2015 Edition)[J].Clin J Hepatology (Electronic Edition),2016(1):2-11.DOI:10.3969/j.issn.1001-5256.2016.07.001.
5 韩环立,张明满,郭春宝,等.胆道闭锁肝移植术后早期肝动脉血栓的诊断及处理[J].临床小儿外科杂志,2017,16(2):138-141,150.DOI:10.3969/j.issn.1671-6353.2017.02.008.Han HL,Zhang MM,Guo CB,et al.Diagnosis and treatment of early-stage hepatic artery thrombosis after liver transplantation for biliary atresia[J].J Clin Ped Sur,2017,16(2):138-141,150.DOI:10.3969/j.issn.1671-6353.2017.02.008.
6 向波,谢小龙.胆道闭锁的"Kasai手术-肝移植"序贯治疗[J].临床小儿外科杂志,2018,17(11):805-808.DOI:10.3969/j.issn.1671-6353.2018.11.002.Xiang B,Xie XL.Sequential treatment of "Kasai surgery-liver transplantation" for biliary atresia[J].J Clin Ped Sur,2018,17(11):805-808.DOI:10.3969/j.issn.1671-6353.2018.11.002.
7 Briceno J,Ciria R,Lopez P,et al.Laparoscopic living donor hepatectomy for pediatric liver transplantation:the first 7 cases in Spain[J].Transplant Proc,2019,51(1):56-57.DOI:10.1016/j.transproceed.2018.03.140.
8 Sahinturk H,Ozdemirkan A,Zeyneloglu P,et al.Risk factors for postoperative prolonged mechanical ventilation after pediatric liver transplantation[J].Exp Clin Transplant,2019,14(10).DOI:10.6002/ect.2018.0317.
9 Yamada N,Inui A,Sanada Y,et al.Pediatric liver transplantation for neonatal-onset Niemann-Pick disease type C:Japanese multicenter experience[J].Pediatr Transplant,2019,23(5):13462.DOI:10.1111/petr.13462.
10 Zhang Y,Wang J,Jin S,et al.Post-traumatic stress disorder in living donors after pediatric liver transplantation:A cross-sectional investigation study[J].Medicine (Baltimore),2019,98(20):15565.DOI:10.1097/MD.0000000000015565.
11 王俊,蔡威,潘伟华,等.肝移植治疗小儿先天性门静脉海绵样变[J].上海交通大学学报(医学版),2006,26(6):643-646.DOI:10.3969/j.issn.1674-8115.2006.06.022.Wang J,Cai W,Pan WH,et al.Cavernous transformation of portal vein in infants treated by liver transplantation[J].Journal of Shanghai Jiao Tong University (Medical Science),2006,26(6):643-646.DOI:10.3969/j.issn.1674-8115.2006.06.022.
12 沈丛欢, 陶一峰,李瑞东,等.儿童肝移植肝动脉显微重建技术探讨[J].肝胆外科杂志,2016,(5):344-346.DOI:10.3969/j.issn.1006-4761.2016.05.006Shen CH,Tao YF,Li RD,et al.Exploring microsurgical techniques for hepatic artery reconstruction during pediatric liver transplantation[J].Journal of Hepatobiliary Surgery,2016,(5):344-346.DOI:10.3969/j.issn.1006-4761.2016.05.006.
13 罗毅,朱建军, 周韬,等.儿童活体肝移植供受者术前评估[J].武汉大学学报:医学版,2016,37(4):607-611.DOI:10.14188/j.1671-8852.2016.04.022.Luo Y,Zhu JJ,Zhou T,et al.Preoperative evaluation for donor and recipient of pediatric living liver transplantation[J].Medical Journal of Wuhan University,2016,37(4):607-611.DOI:10.14188/j.1671-8852.2016.04.022.
14 陈琳,董为,张必翔,等.肝胆胰外科新理念与新技术[J].科学通报,2017,62(1):36-46.DOI:10.1360/N972016-00628.Chen L,Dong W,Zhang BX,et al.New concepts and techniques of hepato-pancreato-biliary surgery[J].Chin Sci Bull,2017,62(1):36-46.DOI:10.1360/N972016-00628.
15 郑树森,吴健.肝移植术后胆道并发症的防治和围手术期处理[J].中华肝脏病杂志,2005,13(3):15-17.DOI:10.3760/j.issn:1007-3418.2005.03.001.Zheng SS,Wu J.Prevention and treatment of biliary complications and management of complications in the perioperative period of liver transplantation[J].Chin J Hepatology,2005,13(3):15-17.DOI:10.3760/j.issn:1007-3418.2005.03.001.
16 李国强,张峰,李相成,等.血管重建技术在预防活体肝移植小移植肝综合征中的地位[J].南京医科大学学报(自然科学版),2010,30(10):1452-1456.Li GQ,Zhang F,Li XC,et al.Role of vascular reconstruction in the prevention of small-for-size syndrome after living donor liver transplantation[J].Acta Universitatis Medicinalis Nanjing(Natural Science),2010,30(10):1452-1456.
17 朱志军,曾志贵.儿童肝移植术后早期血管并发症的诊断、治疗及预防[J].中国普外基础与临床杂志,2015(12):1425-1427.DOI:10.7507/1007-9424.20150374.Zhu ZJ,Zeng ZG.Diagnosis,treatments and preventions of early postoperative vascular complications after hepatic transplantation in children[J].Chin J Bases Clin General Surg,2015(12):1425-1427.DOI:10.7507/1007-9424.20150374.
Memo
收稿日期:2018-04-08。
基金项目:湖南省卫生健康委员会技术创新项目（编号：湘卫医政医管处便函[2018]187号）
通讯作者:尹强,Email:qiangyin@hotmail.com