摘要
目的探讨肝移植术中门静脉血栓的处理方法,评价移植术前门静脉血栓形成对肝移植疗效的影响。方法回顾性分析267例270次肝移植的临床资料。267例受者中,术中明确存在门静脉血栓者21例,占7.8%,其中12例术前通过彩色多普勒超声、计算机断层扫描血管造影或磁共振成像明确诊断。按照Yerdel门静脉血栓分级法,1级8例,2级5例,3级6例,4级2例。肝移植术中根据门静脉血栓分级的不同,采取相应处理方式:1级和2级者选择单纯血栓切除或血栓累及段门静脉切除,然后将供、受者的相应血管行端端吻合;3级和4级者采取供者肠系膜上静脉或髂静脉在供肝门静脉与受者肠系膜上静脉或门静脉系统属支间架桥等方式重建供肝门静脉循环。结果21例术前存在门静脉血栓形成的患者均顺利完成肝移植手术。4例Yerdel分级为3级的受者术后早期(8～21d)死亡,死亡率为19.0%,显著高于术前无门静脉血栓者(8.5%,P<0.01)。21例受者中,1例术后3个月时再次发生门静脉血栓形成,再次血栓形成发生率为4.8%,显著高于术前无门静脉血栓形成者(0.8%,P<0.01)。17例术前存在门静脉血栓形成的患者肝移植后康复出院,其1年存活率为94.1%,与术前无门静脉血栓形成的良性肝病受者(93.8%)比较,差异无统计学意义(P>0.05)。结论术前存在的门静脉血栓形成并非肝移植的绝对禁忌证,术中根据门静脉血栓分级选择适宜的手术处理方式可顺利完成肝移植手术,并取得与无门静脉血栓形成者相近的远期疗效。
Objective To investigate the surgical options in patients with portal vein thrombosis （PVT） in liver transplantation （LTx） and to assess the impact of PVT on LTx outcome. Methods The clinical data of 270 LTx performed for 267 end-stage liver disease patients were retrospectively analyzed. Twenty-one cases （7. 8 %） presented with PVT during transplantation. Twelve of 21 cases of PVT were identified by Doppler color ultrasound, computered tomography angiography or magnetic resonance imagine before LTx. PVT was retrospectively graded according to Yerdel＇s manner： 8 cases of grade 1, 5 cases of grade 2, 6 cases of grade 3, and 2 cases of grade 4. The management of PVT depended mainly on Yerdel＇s grading： Grade 1 and 2 PVT was managed by simple thrombectomy and/ or dissection of PVT portal trunk segment; In grade 3 and grade 4, the distal superior mesentery vein （SMV） or a splanchnic collateral tributary was directly used as an inflow vessel through an interposition donor iliac vein or SMV. Results LTx was successfully performed on all 21 patients presented with PVT. Four patients with grade 3 PVT died perioperati,zely with a significant higher mortality rate （19. 0 %） than that of non-PVT group （8.5 %） （P〈0. 01 ）. Post-LTx PVT occurred in 1/21 （4. 8 %） of the PVT group versus 2/246 （0. 8 %） in the non-PVT group （P〈0. 01 ）. There were no significant differences in actuarial 1-year patient survival rate between the 17 PVT patients （94. 1 %） and non-PVT group （93.8 % ） （P 〉 0. 05 ）. Conclusions PVT is not absolute contraindication for LTx. The ideal treatment for PVT during liver transplantation depends on its Yerdel＇s grading. The same long-term LTx survival results can be achieved in PVT patients as in non-PVT patients.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2006年第1期26-28,共3页
Chinese Journal of Organ Transplantation
关键词
肝移植
门静脉
血栓形成
Liver transplantation
Portal vein
Thrombosis
