Abstract：
There are no standard management protocols for the treatment of bile leak (BL) after liver transplantation. The objective of this study is to describe treatment options for BL after pediatric LT.
METHODS: Retrospective analysis (January 2010-March 2023).
METHODS: preoperative data, status at diagnosis, and postoperative outcome. Four groups: observation (n = 9), percutaneous transhepatic cholangiography (PTC, n = 38), ERCP (2), and surgery (n = 27).
RESULTS: Nine hundred and thirty-one pediatric liver transplantation (859 LDLT and 72 DDT); 78 (8.3%) patients had BL, all in LDLT. The median (IQR) peritoneal bilirubin (PB) level and fluid-to-serum bilirubin ratio (FSBR) at diagnosis was 14.40 mg/dL (8.5-29), and 10.7 (4.1-23.7). Patients who required surgery for treatment underwent the procedure earlier, at a median of 14 days (IQR: 7-19) versus 22 days for PTC (IQR: 15-27, p = 0.002). PB and FSBR were significantly lower in the observation group. In 11 cases, conservative management had resolution of the BL in an average time of 35 days, and 38 patients underwent PTC in a median time of 22 days (15-27). Twenty-seven (34.6%) patients were reoperated as initial treatment for BL in a median time of 17 days (1-108 days); 25 (33%) patients evolved with biliary stricture, 5 (18.5%) after surgery, and 20 (52.6%) after PTC (p = 0.01).
CONCLUSIONS: Patients with BL who were observed presented significantly lower levels of PB and FSBR versus those who underwent PTC or surgery. Patients treated with PTC presented higher rates of biliary stricture during the follow-up.
METHODS: Retrospective analysis (January 2010-March 2023).
METHODS: preoperative data, status at diagnosis, and postoperative outcome. Four groups: observation (n = 9), percutaneous transhepatic cholangiography (PTC, n = 38), ERCP (2), and surgery (n = 27).
RESULTS: Nine hundred and thirty-one pediatric liver transplantation (859 LDLT and 72 DDT); 78 (8.3%) patients had BL, all in LDLT. The median (IQR) peritoneal bilirubin (PB) level and fluid-to-serum bilirubin ratio (FSBR) at diagnosis was 14.40 mg/dL (8.5-29), and 10.7 (4.1-23.7). Patients who required surgery for treatment underwent the procedure earlier, at a median of 14 days (IQR: 7-19) versus 22 days for PTC (IQR: 15-27, p = 0.002). PB and FSBR were significantly lower in the observation group. In 11 cases, conservative management had resolution of the BL in an average time of 35 days, and 38 patients underwent PTC in a median time of 22 days (15-27). Twenty-seven (34.6%) patients were reoperated as initial treatment for BL in a median time of 17 days (1-108 days); 25 (33%) patients evolved with biliary stricture, 5 (18.5%) after surgery, and 20 (52.6%) after PTC (p = 0.01).
CONCLUSIONS: Patients with BL who were observed presented significantly lower levels of PB and FSBR versus those who underwent PTC or surgery. Patients treated with PTC presented higher rates of biliary stricture during the follow-up.
摘要：
肝移植术后胆漏（BL）的治疗没有标准的管理方案。这项研究的目的是描述小儿LT术后BL的治疗选择。
方法：回顾性分析（2010年1月至2023年3月）。
方法：术前数据，诊断时的状态，和术后结果。四组：观察（n=9），经皮肝穿刺胆管造影（PTC，n=38),ERCP(2),和手术（n=27）。
结果：9131例小儿肝移植（859例LDLT和72例DDT）；78例（8.3％）患者患有BL，所有在LDLT。诊断时的中位（IQR）腹膜胆红素（PB）水平和液体与血清胆红素之比（FSBR）为14.40mg/dL（8.5-29），和10.7（4.1-23.7）。需要手术治疗的患者较早接受了手术，中位数为14天（IQR：7-19），PTC为22天（IQR：15-27，p=0.002）。观察组PB和FSBR均显著降低。在11个案例中，保守管理在平均35天的时间内解决了BL，38例患者接受PTC的中位时间为22天（15-27）。27例（34.6％）患者作为BL的初始治疗再次手术，中位时间为17天（1-108天）；25例（33％）患者出现胆道狭窄，5（18.5%）术后，PTC后20(52.6%)(p=0.01)。
结论：观察到的BL患者的PB和FSBR水平明显低于接受PTC或手术的患者。接受PTC治疗的患者在随访期间胆道狭窄的发生率更高。
方法：回顾性分析（2010年1月至2023年3月）。
方法：术前数据，诊断时的状态，和术后结果。四组：观察（n=9），经皮肝穿刺胆管造影（PTC，n=38),ERCP(2),和手术（n=27）。
结果：9131例小儿肝移植（859例LDLT和72例DDT）；78例（8.3％）患者患有BL，所有在LDLT。诊断时的中位（IQR）腹膜胆红素（PB）水平和液体与血清胆红素之比（FSBR）为14.40mg/dL（8.5-29），和10.7（4.1-23.7）。需要手术治疗的患者较早接受了手术，中位数为14天（IQR：7-19），PTC为22天（IQR：15-27，p=0.002）。观察组PB和FSBR均显著降低。在11个案例中，保守管理在平均35天的时间内解决了BL，38例患者接受PTC的中位时间为22天（15-27）。27例（34.6％）患者作为BL的初始治疗再次手术，中位时间为17天（1-108天）；25例（33％）患者出现胆道狭窄，5（18.5%）术后，PTC后20(52.6%)(p=0.01)。
结论：观察到的BL患者的PB和FSBR水平明显低于接受PTC或手术的患者。接受PTC治疗的患者在随访期间胆道狭窄的发生率更高。
