肝移植术后门静脉狭窄18例临床分析

张梅; 张晓刚; 田敏; 师建华; 王荣锋; 刘学民; 王博; 吕毅

doi:10.3969/j.issn.1674-7445.2017.06.007

肝移植术后门静脉狭窄18例临床分析

doi: 10.3969/j.issn.1674-7445.2017.06.007

710061 西安交通大学医学部（张梅、吕毅）；西安交通大学第一附属医院肝胆外科（张梅、张晓刚、田敏、师建华、王荣锋、刘学民、王博、吕毅）

基金项目:

国家自然科学基金项目 81470896

详细信息

通讯作者:
吕毅, Email: luyi169@126.com

中图分类号: R617, R657.3+4
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- 被引次数: 0
出版历程
- 收稿日期: 2017-09-08
- 网络出版日期: 2021-01-19
- 刊出日期: 2017-11-15

Clinical analysis of 18 patients with portal vein stenosis after liver transplantation

Department of Xi'an Jiaotong University, Xi'an 710061, China

More Information

Corresponding author: Lyu Yi, Email: luyi169@126.com

摘要

摘要: 目的总结肝移植术后门静脉狭窄的诊治经验。方法回顾性分析18例肝移植术后门静脉狭窄患者的临床资料，总结门静脉狭窄发生情况、治疗情况及预后。结果 17例患者肝移植术前有肝硬化病史，7例患者肝移植术前有门静脉血栓形成史，8例有脾切除断流或分流等相关手术史；3例为儿童供肝。18例患者门静脉狭窄发生时间为术后23 d~24个月，中位时间为2.2个月，均经彩色多普勒超声（彩超）检查发现，通过门静脉CT血管造影术（CTA）或行介入治疗确诊。所有病例确诊后，均行华法林抗凝治疗；5例有门静脉高压表现的患者行球囊扩张术，其中1例同时放置血管内支架；其余13例采取保守治疗。治疗后9例好转，7例无变化，2例加重。结论对肝移植术前有肝硬化病史的受者，术后常规彩超监测，CTA或介入治疗确诊门静脉狭窄。无临床症状患者可行保守治疗，合并门静脉高压者可行介入治疗，多数病例预后良好。
- 肝移植 /
- 门静脉狭窄 /
- 血管并发症 /
- 肝硬化 /
- 门静脉血栓 /
- CT血管造影术 /
- 球囊扩张成形术 /
- 支架置入术 /
- 抗凝治疗
Abstract: Objective To summarize the experience of clinical diagnosis and treatment of portal vein stenosis after liver transplantation. Methods Clinical data of 18 patients presenting with portal vein stenosis after undergoing liver transplantation were retrospectively analyzed. The incidence, treatment and prognosis of portal vein stenosis were summarized. Results Seventeen patients had a medical history of liver cirrhosis before liver transplantation, 7 cases with a medical history of portal vein thrombosis and 8 cases with a medical history of devascularization or shunt with splenectomy. Three cases received the pediatric liver grafts. Eighteen patients suffered from portal vein stenosis from postoperative 23 d to 24 months with a median time of 2.2 months, which was detected by color Doppler ultrasound (CDU) and diagnosed by CT angiography (CTA) of the portal vein or interventional therapy. After the diagnosis was confirmed, all cases received anticoagulant treatment by warfarin. Five patients with portal hypertension underwent balloon dilatation, and one of them received endovascular stent implantation simultaneously. The remaining 13 patients received conservative therapy. After corresponding treatment, 9 cases were mitigated, 7 patients remained unchanged and 2 cases were aggravated. Conclusions For the recipients with a medical history of liver cirrhosis before liver transplantation, portal vein stenosis should be monitored by conventional CDU and diagnosed by CTA or interventional therapy after transplantation. Patients without clinical symptoms can receive conservative treatment. Those complicated with portal hypertension can undergo interventional therapy. Favorable clinical prognosis is obtained in most cases.
- Liver transplantation /
- Portal vein stenosis /
- Vascular complication /
- Liver cirrhosis /
- Portal vein thrombosis /
- CT angiography /
- Balloon angioplasty /
- Stent implantation /
- Anticoagulant treatment

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图 1 1例门静脉狭窄患者治疗前后的影像学表现

A图为治疗前彩超检查示门静脉主干内径10 mm，为双相血流，入肝瞬时流速209 cm/s，出肝瞬时流速40 cm/s，门静脉吻合口内径2.7 mm，瞬时流速146 cm/s；B图和C图为治疗前CTA显示第一肝门部门静脉主干被稍高密度影包绕，致局部管腔重度狭窄，门静脉高压，胃底静脉增粗迂曲，汇入脾静脉，胃左静脉可见分支与左肾静脉相沟通，门静脉左支主干及属支管腔内低密度充盈缺损影，考虑附壁血栓形成；D图为治疗后1个月彩超显示门静脉主干内可见支架回声，支架外径约8.4 mm，支架内暗区清晰；E图为治疗后1个月彩超显示支架血流充盈良好，瞬时流速46 cm/s

Figure 1. Imaging findings of one patient with portal vein stenosis before and after treatment

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