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摘要: 门静脉血栓(PVT)的处理目前仍然是肝移植手术技术方面的一大挑战,复杂的PVT需要根据血栓的范围、机化及其与血管壁的粘连程度、侧支血管的代偿分流情况等,选择最适合的处理方案,以达到最佳的疗效。本文提出了一种基于门静脉取栓后血流再通情况和门静脉重建方案的PVT分类方法, 并进一步分析了3类PVT相应的处理方案。采用基于门静脉重建方案的PVT分类,对PVT患者肝移植的预后具有较为准确的评估价值,可以尝试在临床治疗中推广应用。
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表 1 基于门静脉重建方案的PVT分类方法
Table 1. PVT classification method based on the program of portal vein reconstruction
PVT分类 取栓后门静脉血流恢复情况 门静脉重建方案 Ⅰ类 门静脉血流满足移植肝灌注要求 常规供受体门静脉端端吻合 Ⅱ类 门静脉血流达不到基本的移植肝灌注要求 移植肝血流来自受体门静脉系统 Ⅲ类 门静脉血流达不到基本的移植肝灌注要求 移植肝血流来自受体非门静脉系统 -
[1] FUKUI H, SAITO H, UENO Y, et al. Evidence-based clinical practice guidelines for liver cirrhosis 2015[J]. J Gastroenterol, 2016, 51(7): 629-650. DOI: 10.1007/s00535-016-1216-y. [2] FRANCOZ C, VALLA D, DURAND F. Portal vein thrombosis, cirrhosis, and liver transplantation[J]. J Hepatol, 2012, 57(1): 203-312. DOI: 10.1016/j.jhep.2011.12.034. [3] GHABRIL M, AGARWAL S, LACERDA M, et al. Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation: analysis of risk factors and outcomes for portal vein thrombosis in waitlisted patients[J]. Transplantation, 2016, 100(1): 126-133. DOI: 10.1097/TP.0000000000000785. [4] YERDEL MA, GUNSON B, MIRZA D, et al. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome[J]. Transplantation, 2000, 69(9): 1873-1881. doi: 10.1097/00007890-200005150-00023 [5] HIBI T, NISHIDA S, LEVI DM, et al. When and why portal vein thrombosis matters in liver transplantation: a critical audit of 174 cases[J]. Ann Surg, 2014, 259(4): 760-766. DOI: 10.1097/SLA.0000000000000252. [6] 潘澄, 史源, 邓永林, 等.外翻式门静脉血栓切除术在肝移植术中的应用[J].中华外科杂志, 2009, 47(22): 1681-1684. DOI: 10.3760/cma.j.issn.0529-5815.2009.22.001.PAN C, SHI Y, DENG YL, et al. Application of eversion embolectomy for portal vein thrombosis on liver transplantation[J]. Chin J Surg, 2009, 47(22): 1681-1684. DOI: 10.3760/cma.j.issn.0529-5815.2009.22.001. [7] NAZZAL M, SUN Y, OKOYE O, et al. Reno-portal shunt for liver transplant, an alternative inflow for recipients with grade Ⅲ-Ⅳ portal vein thrombosis: tips for a better outcome[J]. Int J Surg Case Rep, 2017, 41: 251-254. DOI: 10.1016/j.ijscr.2017.09.028. [8] RODRÍGUEZ-CASTRO KI, PORTE RJ, NADAL E, et al. Management of nonneoplastic portal vein thrombosis in the setting of liver transplantation: a systematic review[J]. Transplantation, 2012, 94(11): 1145-1153. DOI: 10.1097/TP.0b013e31826e8e53. [9] HWANG HP, YANG JD, BAE SI, et al. Usefulness of artificial jump graft to portal vein thrombosis in deceased donor liver transplantation[J]. Yonsei Med J, 2015, 56(2): 586-590. DOI: 10.3349/ymj.2015.56.2.586. [10] LLADÓ L, FABREGAT J, CASTELLOTE J, et al. Management of portal vein thrombosis in liver transplantation: influence on morbidity and mortality[J]. Clin Transplant, 2007, 21(6): 716-721. [11] CHEN TH, JENG LB, LEE CC, et al. Polytetrafluoroethylene patch venoplasty for outflow reconstruction in living donor liver transplantation: two case reports[J]. Transplant Proc, 2008, 40(8): 2529-2530. DOI: 10.1016/j.transproceed.2008.07.035. [12] MOON DB, LEE SG, AHN CS, et al. Section 6. management of extensive nontumorous portal vein thrombosis in adult living donor liver transplantation[J]. Transplantation, 2014, 97(Suppl 8): S23-S30. DOI: 10.1097/01.tp.0000446270.20934.05. [13] MANZIA TM, FAZZOLARI L, MANUELLI M, et al. Liver transplantation in a patient with complete portal vein thrombosis, is there a surgical way out? a case report[J]. Ann Med Surg (Lond), 2016, 11:5-8. DOI: 10.1016/j.amsu.2016.08.002. [14] TZAKIS AG, KIRKEGAARD P, PINNA AD, et al. Liver transplantation with cavoportal hemitransposition in the presence of diffuse portal vein thrombosis[J]. Transplantation, 1998, 65(5): 619-624. doi: 10.1097/00007890-199803150-00004 [15] SELVAGGI G, WEPPLER D, NISHIDA S, et al. Ten-year experience in porto-caval hemitransposition for liver transplantation in the presence of portal vein thrombosis[J]. Am J Transplant, 2007, 7(2): 454-460. doi: 10.1111/ajt.2007.7.issue-2 [16] TAO YF, TENG F, WANG ZX, et al. Liver transplant recipients with portal vein thrombosis: a single center retrospective study[J]. Hepatobiliary Pancreat Dis Int, 2009, 8(1): 34-39. http://cn.bing.com/academic/profile?id=739e70e649c48ce823a3ae46d3bec3a3&encoded=0&v=paper_preview&mkt=zh-cn [17] BHANGUI P, LIM C, SALLOUM C, et al. Caval inflow to the graft for liver transplantation in patients with diffuse portal vein thrombosis: a 12-year experience[J]. Ann Surg, 2011, 254(6): 1008-1016. DOI: 10.1097/SLA.0b013e31822d7894. [18] BHANGUI P, SALLOUM C, LIM C, et al. Portal vein arterialization: a salvage procedure for a totally de-arterialized liver. the Paul Brousse Hospital experience[J]. HPB (Oxford), 2014, 16(8): 723-738. DOI: 10.1111/hpb.12200. [19] SETTMACHER U, STANGE B, SCHASER KD, et al. Primary permanent arterialization of the portal vein in liver transplantation[J]. Transpl Int, 2003, 16(6): 430-433. doi: 10.1111/tri.2003.16.issue-6 [20] NIVATVONGS S, SIRIJINDAKUL B, NONTASOOT B.Portal vein arterialization for liver transplantation with extensive portomesenteric vein thrombosis: a case report[J]. Transplant Proc, 2004, 36(8): 2267-2268. doi: 10.1016/j.transproceed.2004.07.073 [21] OTT R, BÖHNER C, MÜLLER S, et al. Outcome of patients with pre-existing portal vein thrombosis undergoing arterialization of the portal vein during liver transplantation[J]. Transpl Int, 2003, 16(1): 15-20. doi: 10.1111/tri.2003.16.issue-1 [22] PALOYO S, NISHIDA S, FAN J, et al. Portal vein arterialization using an accessory right hepatic artery in liver transplantation[J]. Liver Transpl, 2013, 19(7): 773-775. DOI: 10.1002/lt.23653. [23] VIANNA RM, MANGUS RS, KUBAL C, et al. Multivisceral transplantation for diffuse portomesenteric thrombosis[J]. Ann Surg, 2012, 255(6): 1144-1150. DOI: 10.1097/SLA.0b013e31825429c0.