胆道闭锁婴儿亲属活体肝移植术后空肠穿孔四例

目的 分析胆道闭锁婴儿亲属活体肝移植术后空肠穿孔的原因,总结治疗经验.方法 胆道闭锁婴儿行亲属活体肝移植者28例,术后应用环孢素A、糖皮质激素预防排斥反应,部分患儿加用吗替麦考酚酯.结果28例中4例(14.3%)发生空肠穿孔,共发生7次,发生时间平均为术后11 d(8～13 d).4例的穿孔部位均在空肠,其中3例在肠吻合口丝线缝合线脚处,1例在肠袢臂固定丝线线头处.肠吻合口丝线缝合线脚处穿孔的3例经丝线缝合修补穿孔后,其中2例(67%)再次出现穿孔,用prolene线修补后愈合.无患儿因空肠穿孔而死亡.结论 胆道闭锁婴儿行亲属活体肝移植后发生空肠穿孔可能与用丝线吻合肠道有关,可换用Prolene线吻合肠道或修补穿孔.早期诊断和早期剖腹探查对空肠穿孔的治疗至关重要.

Abstract：

Objective To investigate the cause of jejunum perforation after infantile livingrelated liver transplantation (ILRLT) and summarize the experience of treatment. Methods The clinical data of 28 infants with biliary atresia who underwent ILRLT were analyzed and 4 of 28 infantile recipients (14. 3%) developed jejunum perforation after ILDLT. Results Four patients had 7 episodes of jejunum perforation after transplantation among 28 infantile recipients who underwent ILRLT because of biliary atresia. The median time between transplantation and perforation was 11 days.Perforation occurred at the point of silk in jejunum stoma (n = 3) and the Roux-en-Y limb (n = 1 ).None had a history of prior operation including Kasai in 4 patients. Clinical manifestation included fever, increased heart rate, abdominal distention, leukocytosis, and no free air on abdominal roentgenograrns. A simple repair was performed in three infants with silk: two developed recurrent perforation (67%) and underwent a re-exploration,and another had a third perforation and underwent a third repair because of re-perforation. Another child underwent a simple repair with prolene, and there was no recurrence. None died from the perforation in our study. Conclusion The occurrence and location of jejunum perforation after ILDLT suggests that the cause of the perforation is related to the jejunal anastomosis with silk, and the jejunum perforation may be avoided in the jejunal anastomosis with prolene. Early diagnosis and exploration may ensure better survival.

Treatment of jejunum perforation after living-related liver transplantation for infants with biliary atresia a report of 4 cases

Objective To investigate the cause of jejunum perforation after infantile livingrelated liver transplantation (ILRLT) and summarize the experience of treatment. Methods The clinical data of 28 infants with biliary atresia who underwent ILRLT were analyzed and 4 of 28 infantile recipients (14. 3%) developed jejunum perforation after ILDLT. Results Four patients had 7 episodes of jejunum perforation after transplantation among 28 infantile recipients who underwent ILRLT because of biliary atresia. The median time between transplantation and perforation was 11 days.Perforation occurred at the point of silk in jejunum stoma (n = 3) and the Roux-en-Y limb (n = 1 ).None had a history of prior operation including Kasai in 4 patients. Clinical manifestation included fever, increased heart rate, abdominal distention, leukocytosis, and no free air on abdominal roentgenograrns. A simple repair was performed in three infants with silk: two developed recurrent perforation (67%) and underwent a re-exploration,and another had a third perforation and underwent a third repair because of re-perforation. Another child underwent a simple repair with prolene, and there was no recurrence. None died from the perforation in our study. Conclusion The occurrence and location of jejunum perforation after ILDLT suggests that the cause of the perforation is related to the jejunal anastomosis with silk, and the jejunum perforation may be avoided in the jejunal anastomosis with prolene. Early diagnosis and exploration may ensure better survival.