留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

肝移植中基于门静脉重建方案的门静脉血栓分类及处理策略

滕飞 傅志仁

滕飞, 傅志仁. 肝移植中基于门静脉重建方案的门静脉血栓分类及处理策略[J]. 器官移植, 2018, 9(4): 245-249. doi: 10.3969/j.issn.1674-7445.2018.04.001
引用本文: 滕飞, 傅志仁. 肝移植中基于门静脉重建方案的门静脉血栓分类及处理策略[J]. 器官移植, 2018, 9(4): 245-249. doi: 10.3969/j.issn.1674-7445.2018.04.001

肝移植中基于门静脉重建方案的门静脉血栓分类及处理策略

doi: 10.3969/j.issn.1674-7445.2018.04.001
基金项目: 

国家自然科学基金 81470900

国家自然科学基金 81702923

上海市“科技创新行动计划”医学领域科技支撑项目 15411950403

海军军医大学精准医学转化应用研究专项 2017JZ50

详细信息
    作者简介:

    滕飞,男,1982年生,博士,主治医师,研究方向为肝癌肝移植的临床与基础,Email:flyteng5635@vip.sina.com

    傅志仁,教授、主任医师、博士研究生导师。现任海军军医大学附属长征医院解放军器官移植研究所所长,兼任中国医师协会器官移植医师分会移植外科技术专委会及上海市医学会器官移植专科分会主任委员、解放军器官移植专业委员会及中国免疫学会移植免疫分会副主任委员、中华医学会器官移植学分会及中国医师协会器官移植医师分会常务委员等。从事肝胆外科30余年,在各种肝叶段切除、肝癌复杂手术以及肝移植方面拥有丰富的经验。1996年成功实施了国内首例儿童肝移植,保持着国内单次肝移植最长存活记录(20年)。承担国家及省部级课题10余项,以第一或通讯作者发表SCI论文18篇,以第一完成人获得省部级二等以上成果奖励4项,主编或参编专著6部。

    通讯作者:

    傅志仁,男,主任医师,博士研究生导师,研究方向为肝胆外科、肝移植,Email:zhirenf@smmu.edu.cn

  • 中图分类号: R617, R364.1+5

  • 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。

     

  • 图  1  改良式腔-门静脉半转位

    PV为门静脉,SV为脾静脉,SMV为肠系膜上静脉

    Figure  1.  Modified cavity-portal vein hemitransposition

    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
    下载: 导出CSV
  • [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.
  • 加载中
图(1) / 表(1)
计量
  • 文章访问数:  134
  • HTML全文浏览量:  68
  • PDF下载量:  14
  • 被引次数: 0
出版历程
  • 收稿日期:  2018-04-10
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2018-07-15

目录

    /

    返回文章
    返回