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儿童活体肝移植术后罕见并发症——右侧膈疝

曲伟 朱志军 魏林 孙丽莹 曾志贵 刘颖 王君 檀玉乐 张梁 何恩辉

曲伟, 朱志军, 魏林, 等. 儿童活体肝移植术后罕见并发症——右侧膈疝[J]. 器官移植, 2020, 11(4): 461-465. doi: 10.3969/j.issn.1674-7445.2020.04.006
引用本文: 曲伟, 朱志军, 魏林, 等. 儿童活体肝移植术后罕见并发症——右侧膈疝[J]. 器官移植, 2020, 11(4): 461-465. doi: 10.3969/j.issn.1674-7445.2020.04.006
Qu Wei, Zhu Zhijun, Wei Lin, et al. Rare complication after pediatric living donor liver transplantation: right diaphragmatic hernia[J]. ORGAN TRANSPLANTATION, 2020, 11(4): 461-465. doi: 10.3969/j.issn.1674-7445.2020.04.006
Citation: Qu Wei, Zhu Zhijun, Wei Lin, et al. Rare complication after pediatric living donor liver transplantation: right diaphragmatic hernia[J]. ORGAN TRANSPLANTATION, 2020, 11(4): 461-465. doi: 10.3969/j.issn.1674-7445.2020.04.006

儿童活体肝移植术后罕见并发症——右侧膈疝

doi: 10.3969/j.issn.1674-7445.2020.04.006
基金项目: 

首都临床特色应用研究 Z181100001718220

详细信息
    作者简介:

    曲伟,男,1981年生,博士,副主任医师,研究方向为肝移植,Email:fchquwei@hotmail.com

    通讯作者:

    朱志军,男,1968年,博士,主任医师,研究方向为肝移植,Email:zhu-zhijun@outlook.com

  • 中图分类号: R617, R256.45

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

More Information
  • 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。

     

  • 图  1  例1患儿膈疝的影像学表现

    注:A图示胸腹联合CT表现为右侧膈疝;B图为术前CT显示膈疝内容物含右肾;C图示膈肌缺损4 cm×3 cm,未见囊腔。

    Figure  1.  Imaging manifestations of diaphragmatic hernia in case 1 child

    图  2  例2患儿膈疝的影像学表现

    注:A图为X线胸片显示右侧胸腔充满肠袢,符合右侧膈疝影像表现;B图为胸腹联合CT检查显示膈疝内容物含右肾;C图为常规腹部超声检查提示肝内胆管扩张。

    Figure  2.  Imaging manifestations of diaphragmatic hernia in case 2 child

    图  3  例3患儿膈疝的影像学表现

    注:A图为膈疝发生前1 d胸部CT检查显示右侧膈肌薄弱区;B图为X线胸片显示右侧胸腔内充满肠袢伴有典型胃肠道梗阻表现,符合膈疝诊断;C图示一期缝合进行膈肌缺损修补。

    Figure  3.  Imaging manifestations of diaphragmatic hernia in case 3 child

    表  1  3例儿童活体肝移植受者临床资料

    Table  1.   Clinical data of 3 recipients undergoing pediatric living donor liver transplantation

    例序 手术史 PELD
    评分(分)
    移植物
    重量(g)
    GRWR
    (%)
    术程
    (min)
    例1 Kasai术 12 255 3.92 405
    例2 Kasai术 8 282 3.03 390
    例3 Kasai术 8 245 3.50 430
    注:①Kasai术为肝门空肠吻合术。
    ②PELD为儿童终末期肝病模型。
    ③GRWR为移植物与受者质量比。
    下载: 导出CSV
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出版历程
  • 收稿日期:  2020-04-16
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2020-07-15

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