CANLI DONÖR KARACİĞER NAKİL SONRASI BİLİYER KAÇAKLARIN PERKÜTAN TEDAVİSİ

Amaç: Biliyer kaçak (BK), canlı donör karaciğer nakli (CDKN) sonrası sık görülen komplikasyonlar arasındadır. Radyolojik yöntemler, tanıda ve tedavide önemlidir. Endoskopik yaklaşımlar BK’larda ilk basamak tedavi seçeneği kabul edilmekle birlikte günümüzde artan deneyim girişimsel radyolojik yaklaşımların rolunü de giderek arttırmaktadır. Çalışmamızda, CDKN sonrası gelişen BK’ların tanı ve tedavisinde deneyimimizi analiz etmeyi amaçlıyoruz. Gereç ve Yöntemler: Ocak 2015 – Aralık 2018 arasında merkezimizde gerçekleştirilen ardışık 361 CDKT olgu retrospektif olarak analiz edildi. BK şüphesi bulunan hastalarda kaçak tanısı ve yeri, safra yollarından ekskrete edilen gadoksetate disodyum kontrast madde kullanarak alınan manyetik rezonans kolanjiyopankreatografi (MRKP) ile gösterildi. Safra kaçakları, endoskopik, girişimsel radyolojik yaklaşımlar, cerrahi ve konservatif olarak tedavi edildi. Bulgular: Total 361 olgunun 27’sinde (%7,4) BK mevcut idi. BK’ların 26’sı (%96,2) anastomotik, 1’i ise (%3,7) kesi yüzey kaçağı idi. Bir hasta (%3,7) endoskopik, 23 hasta (% 85,1) girişimsel radyolojik, iki hasta (%7,4) cerrahi ve bir hasta (%3,7) konservatif yaklaşım ile tedavi edildi. Girişimsel radyolojik işlemler sırasında herhangi minor ve major komplikasyon gelişmedi. İşlem sonrasında ise 6 hastada (%26) minor komplikasyon [4 (%17,4) hafif kolanjitik atak, 2 (%8,6) hafif ödematöz pankreatit] gelişti. Sonuç: CDKT sonrası safra yollarının çoklu anastomozlu olması endoskopik tedavi yaklaşımlarını zorlaştırmaktadır. Girişimsel radyolojik yaklaşımlar deneyim gerektirmekle birlikte alternatif yöntem olarak uygulanabilir.

Anahtar Kelimeler:

Biliyer kaçak, canlı karaciğer nakli, perkütan tedavi

PERCUTANEOUS TREATMENT OF BILE LEAKAGE AFTER LIVING DONOR LIVER TRANSPLANTATION

Objective: Biliary leakage (BL) is one of the most frequent complications following living donor liver transplantation (LDLT). Radiological methods are important in diagnosis and treatment. Although endoscopic approaches are considered as the firstline treatment option in BL, nowadays, increasing experience is strengthening the role of interventional radiological approaches. In our article, we aim to analyze our experience in the diagnosis and treatment of BLs developed after LDLT. Material and methods: Between January 2015 and December 2018, 361 LDLT cases performed consecutive at our center were analyzed retrospectively. The leakage diagnosis and location was demonstrated by magnetic resonance cholangiopancreatography (MRCP) with hepatobiliary excreted contrast agent gadoxetate disodium in patients with suspected leakage. BLs were treated by endoscopic, interventional radiological, surgical or conservative approaches. Results: Of the total 361 cases, 27 (7.4%) had BL. Twenty six (96%) of the BL were anastomotic and 1 (3,7%) was incision surface leakage. One patient (3.7%) was treated by endoscopic sphincterotomy methods, 23 (85,1%) patients by interventional radiological approaches, two patients (7.4%) by surgery and 1 patient (3,7%) by conservative approaches. There were no minor and major complications during interventional radiological procedures. After the procedure, minor complications (mild cholangitic attack) in 4 (17.4%), mild edematous pancreatitis in 2 (8,6%) developed in 6 (26%) patients. Conclusion: Endoscopic treatment approaches may be complicated in patients with multiple anastomosis of biliary tract after LDLT. Although interventional radiological approaches require experience, they can be performed as an alternative treatment method.

Keywords:

Biliary leakage, living donor liver transplantation, percutaneous treatment,

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