儿童活体肝移植术后罕见并发症——右侧膈疝  

Rare complication after pediatric living donor liver transplantation:right diaphragmatic hernia

作　　者：曲伟[1,2] 朱志军 魏林[1] 孙丽莹 曾志贵[1] 刘颖[1] 王君[1] 檀玉乐[1] 张梁[1] 何恩辉 Qu Wei;Zhu Zhijun;Wei Lin;Sun Liying;Zeng Zhigui;Liu Ying;Wang Jun;Tan Yule;Zhang Liang;He Enhui(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普通外科,100050 [2]首都医科大学儿童肝脏移植临床诊疗与研究中心国家消化系统疾病临床研究中心

出　　处：《器官移植》2020年第4期461-465,共5页Organ Transplantation

基　　金：首都临床特色应用研究(Z181100001718220)。

摘　　要：目的分析儿童活体肝移植术后发生右侧膈疝的临床特点、致病原因和治疗经验。方法回顾性分析3例儿童活体肝移植术后发生右侧膈疝受者的临床资料,分析其临床特点和诊疗经过,总结治疗经验。结果3例活体肝移植术后发生膈疝患儿的原发性疾病均是胆道闭锁。膈疝发生时间为肝移植术后4~6个月。膈疝内容物包括腹膜内位和腹膜间位的组织和器官。膈肌缺损均位于右膈后内侧区,术中行一期间断缝合修补,长期随访无膈疝复发。结论儿童活体肝移植术后发生右侧膈疝的临床表现多样,危险因素包括营养不良状态、低体质量、手术创伤、胆漏导致的化学腐蚀、局灶性感染以及胸膜-腹腔内压力梯度等。手术干预是肝移植术后膈疝的首选治疗策略。Objective To analyze the clinical characteristics,pathogenic causes and therapeutic experience of right diaphragmatic hernia after pediatric living donor liver transplantation.Methods Clinical data of 3 recipients with right diaphragmatic hernia after pediatric living donor liver transplantation were retrospectively analyzed.The clinical characteristics,diagnosis and treatment process and therapeutic experience were analyzed and summarized.Results The primary diseases of 3 children with diaphragmatic hernia after living donor liver transplantation were biliary atresia.The diaphragmatic hernia occurred at 4-6 months after liver transplantation.The contents of diaphragmatic hernia included the intraperitoneal and interperitoneal tissues and organs.Diaphragmatic defects were all located in the posterior medial area of the right diaphragm.The primary stage intermittently suturing repair was performed during intraoperative period.No diaphragmatic hernia recurred during long-term follow-up.Conclusions The clinical manifestations of right diaphragmatic hernia after pediatric living donor liver transplantation are diverse.The risk factors include malnutrition,low body weight,surgical trauma,chemical erosion caused by bile leakage,focal infection and pleural-peritoneal pressure gradient,etc.Surgical intervention is the preferred treatment strategy for diaphragmatic hernia after liver transplantation.

关 键 词：儿童肝移植 活体肝移植 膈疝 胆道闭锁 碱性磷酸酶 门静脉高压 胆漏 

分 类 号：R617[医药卫生—外科学] R256.45[医药卫生—临床医学]