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

肝动脉溶栓联合脾动脉栓塞术治疗肝移植术后肝动脉血栓的临床分析

张锡武 匡悦

张锡武, 匡悦. 肝动脉溶栓联合脾动脉栓塞术治疗肝移植术后肝动脉血栓的临床分析[J]. 器官移植, 2020, 11(5): 594-598. doi: 10.3969/j.issn.1674-7445.2020.05.011
引用本文: 张锡武, 匡悦. 肝动脉溶栓联合脾动脉栓塞术治疗肝移植术后肝动脉血栓的临床分析[J]. 器官移植, 2020, 11(5): 594-598. doi: 10.3969/j.issn.1674-7445.2020.05.011
Zhang Xiwu, Kuang Yue. Clinical analysis of hepatic arterial thrombolysis combined with splenic arterial embolization in treatment of hepatic arterial thrombosis after liver transplantation[J]. ORGAN TRANSPLANTATION, 2020, 11(5): 594-598. doi: 10.3969/j.issn.1674-7445.2020.05.011
Citation: Zhang Xiwu, Kuang Yue. Clinical analysis of hepatic arterial thrombolysis combined with splenic arterial embolization in treatment of hepatic arterial thrombosis after liver transplantation[J]. ORGAN TRANSPLANTATION, 2020, 11(5): 594-598. doi: 10.3969/j.issn.1674-7445.2020.05.011

肝动脉溶栓联合脾动脉栓塞术治疗肝移植术后肝动脉血栓的临床分析

doi: 10.3969/j.issn.1674-7445.2020.05.011
基金项目: 广东省医学科研基金(A2020523)
详细信息
    作者简介:

    张锡武,男,1986年生,博士,主治医师,研究方向为外周血管和综合介入治疗,Email:zxwdqq@163.com

    通讯作者:

    匡悦,男,1984年生,博士研究生,主治医师,研究方向为肝胆疾病外科诊疗方向的研究,Email:fimmu_ky@163.com

  • 中图分类号: R617, R735.7

Clinical analysis of hepatic arterial thrombolysis combined with splenic arterial embolization in treatment of hepatic arterial thrombosis after liver transplantation

More Information
  • 摘要:   目的  分析经导管肝动脉溶栓联合脾动脉栓塞术在肝移植术后肝动脉血栓(HAT)治疗中的临床疗效。  方法  回顾性分析因肝移植术后HAT行经导管肝动脉溶栓联合脾动脉栓塞术的9例患者的临床资料。总结HAT的发生情况和溶栓治疗情况;总结溶栓相关并发症的发生情况和预后情况;分析典型病例的溶栓治疗过程。  结果  HAT发现时间为肝移植术后1~66 d,中位时间10 d。HAT形成部位分别为肝动脉主干吻合口处8例,右支1例。9例均为发现当日急诊行经导管肝动脉溶栓联合脾动脉栓塞术。肝动脉术中开通4例,术后留置导管溶栓开通3例,开通时间为72~96 h,总开通率为7/9。术后溶栓相关并发症为腹腔出血1例。死亡3例,死因分别为肝动脉开通失败后死于肝衰竭和感染2例,介入治疗后70 d死于胆道缺血及全身感染1例。  结论  肝动脉溶栓联合脾动脉栓塞术对于肝移植术后HAT的治疗具有良好的临床疗效,可作为无条件再次肝移植情况下的首选治疗方案。

     

  • 图  1  1例肝移植术后HAT患者行经导管肝动脉溶栓联合脾动脉栓塞术的术中造影

    注:A图示造影可见肝固有动脉主干闭塞;B图示微导管通过闭塞部位,造影显示远端血管通畅;C图示15 min内注入尿激酶10万单位,造影显示肝动脉部分开通;D图示留置导管溶栓24 h后复查造影见肝固有动脉开通,但吻合口附近血栓残留,管腔不规则狭窄;E图示48 h后复查造影见肝固有动脉及其分支血流通畅良好。

    Figure  1.  Intraoperative angiography of transcatheter hepatic artery thrombolysis combined with splenic artery embolization performed in 1 patient with HAT after liver transplantation

    表  1  9例肝移植术后HAT患者的介入治疗和预后情况

    Table  1.   Interventional therapy and prognosis of 9 cases of HAT patients after liver transplantation

    例序 性别 年龄(岁) HAT发生情况 介入治疗情况 溶栓相关并发症 预后
    肝移植术后时间(d) 部位 术式 溶栓时间(h) 尿激酶用量(万单位) 再通时间
    1 47 11 主干 CDT+SAE 72 100 术中 良好
    2 51 11 主干 CDT+SAE 72 85 术中 良好
    3 45 10 主干 CDT+SAE+GDAE 96 110 96h 死亡
    4 58 3 主干 CDT+SAE 12 40 未开通 腹腔出血 死亡
    5 56 66 主干 CDT+SAE 48 90 术中 良好
    6 42 30 主干 CDT+SAE 48 80 未开通 死亡
    7 41 3 右支 CDT+SAE 72 80 术中 良好
    8 56 1 主干 CDT+SAE 96 90 96h 良好
    9 69 2 主干 CDT+SAE 96 110 72h 良好
    注:①为经导管肝动脉溶栓。
    ②为脾动脉栓塞术。
    ③为胃十二指肠动脉栓塞术。
    下载: 导出CSV
  • [1] CHOI HJ, KIM DG, KIM Y, et al. Clinical course of hepatic artery thrombosis after living donor liver transplantation using the right lobe[J]. Liver Transpl, 2018, 24(11):1554-1560. DOI: 10.1002/lt.25065.
    [2] FUJIKI M, HASHIMOTO K, PALAIOS E, et al. Probability, management, and long-term outcomes of biliary complications after hepatic artery thrombosis in liver transplant recipients[J]. Surgery, 2017, 162(5):1101- 1111. DOI: 10.1016/j.surg.2017.07.012.
    [3] DOMINGUEZ BASTANTE M, MOLINA RAYA A, VILCHEZ RABELO A, et al. Analysis of ischemic cholangiopathy after treatment of arterial thrombosis in liver transplantation in our series[J]. Transplant Proc, 2018, 50(2):628-630. DOI: 10.1016/j.transproceed.2017.11.062.
    [4] LUI SK, GARCIA CR, MEI X, et al. Re-transplantation for hepatic artery thrombosis: a national perspective[J]. World J Surg, 2018, 42(10):3357-3363. DOI: 10.1007/ s00268-018-4609-7.
    [5] PEREIRA K, SALSAMENDI J, DALAL R, et al. Percutaneous endovascular therapeutic options in treating posttransplant hepatic artery thrombosis with the aim of salvaging liver allografts: our experience[J]. Exp Clin Transplant, 2016, 14(5): 542-550. DOI: 10.6002/ ect.2015.0189.
    [6] PIARDI T, LHUAIRE M, BRUNO O, et al. Vascular complications following liver transplantation: a literature review of advances in 2015[J]. World J Hepatol, 2016, 8(1): 36-57. DOI: 10.4254/wjh.v8.i1.36.
    [7] NÜSSLER NC, SETTMACHER U, HAASE R, et al. Diagnosis and treatment of arterial steal syndromes in liver transplant recipients[J]. Liver Transpl, 2003, 9(6): 596-602. DOI: 10.1053/jlts.2003.50080.
    [8] MOURAD MM, LIOSSIS C, GUNSON BK, et al. Etiology and management of hepatic artery thrombosis after adult liver transplantation[J]. Liver Transpl, 2014, 20(6): 713-723. DOI: 10.1002/lt.23874.
    [9] XUE Z, CHEN M, ZHANG X, et al. Analysis of early hepatic artery thrombosis after liver transplantation[J]. ANZ J Surg, 2018, 88(3): 172-176. DOI: 10.1111/ans.13911.
    [10] FOUZAS I, PAPANIKOLAOU C, KATSANOS G, et al. Hepatic artery anatomic variations and reconstruction in liver grafts procured in Greece: the effect on hepatic artery thrombosis[J]. Transplant Proc, 2019, 51(2):416- 420. DOI: 10.1016/j.transproceed.2019.01.078.
    [11] HERRERO A, SOUCHE R, JOLY E, et al. Early hepatic artery thrombosis after liver transplantation: what is the impact of the arterial reconstruction type?[J]. World J Surg, 2017, 41(8):2101-2110. DOI: 10.1007/s00268-017- 3989-4.
    [12] INCE V, ERSAN V, KARAKAS S, et al. Does preoperative transarterial chemoembolization for hepatocellular carcinoma increase the incidence of hepatic artery thrombosis after living-donor liver transplant?[J]. Exp Clin Transplant, 2017, 15(Suppl 2):21-24. DOI: 10.6002/ect.TOND16.L7.
    [13] 叶征辉, 赵红川, 耿小平, 等.同种异体原位肝移植的复杂肝动脉重建经验总结[J].器官移植, 2019, 10(5): 589-593, 611. DOI: 10.3969/j.issn.1674-7445.2019.05.020.

    YE ZH, ZHAO HC, GENG XP, et al. Experience summary of complex hepatic artery reconstruction in orthotopic liver transplantation[J]. Organ Transplant, 2019, 10(5):589- 593, 611. DOI: 10.3969/j.issn.1674-7445.2019.05.020.
    [14] PARK GC, MOON DB, KANG SH, et al. Overcoming hepatic artery thrombosis after living donor liver transplantations: an experience from Asan medical center[J]. Ann Transplant, 2019, 24:588-593. DOI: 10.12659/AOT.919650.
    [15] ZHANG H, QIAN S, LIU R, et al. Interventional treatment for hepatic artery thrombosis after liver transplantation[J]. J Vasc Interv Radiol, 2017, 28(8): 1116-1122. DOI: 10.1016/j.jvir.2017.04.026.
    [16] MURATA Y, MIZUNO S, KATO H, et al. Technical feasibility and clinical outcomes of interventional endovascular treatment for hepatic artery thrombosis after living-donor liver transplantation[J]. Transplant Proc, 2016, 48(4): 1142-1148. DOI: 10.1016/j.transproceed. 2015.12.092.
    [17] ESPOSITO A, VIT A, ADANI G, et al. Indigo thrombectomy system for hepatic artery thrombosis after liver transplantation: a case report[J]. Transplant Proc, 2018, 50(10):4000-4003. DOI: 10.1016/j.transproceed. 2018.07.036.
    [18] 吴宝林, 周军, 李小奇, 等.成人肝移植术后急性肝动脉血栓介入治疗的疗效分析[J].武汉大学学报(医学版), 2017, 38(3): 495-498, 504. DOI: 10.14188/ j.1671-8852.2017.03.033.

    WU BL, ZHOU J, LI XQ, et al. Outcomes of interventional treatment for hepatic artery thrombosis after adult liver transplantation[J]. Med J Wuhan Univ, 2017, 38(3): 495- 498, 504. DOI: 10.14188/j.1671-8852.2017.03.033.
    [19] SINGHAL A, STOKES K, SEBASTIAN A, et al. Endovascular treatment of hepatic artery thrombosis following liver transplantation[J]. Transpl Int, 2010, 23(3): 245-256. DOI: 10.1111/j.1432-2277.2009.01037.x.
    [20] 张华, 王建华, 颜志平, 等.肝移植术后急性肝动脉血栓形成的介入治疗[J].复旦学报(医学版), 2017, 44(2): 181-185, 212. DOI: 10.3969/j.issn.1672-8467.2017.02.009.

    ZHANG H, WANG JH, YAN ZP, et al. Interventional therapy for acute hepatic artery thrombosis after liver transplantation[J]. Fudan Univ J Med Sci, 2017, 44(2): 181-185, 212. DOI: 10.3969/j.issn.1672-8467.2017.02.009.
    [21] LEE IJ, KIM SH, LEE SD, et al. Feasibility and midterm results of endovascular treatment of hepatic artery occlusion within 24 hours after living-donor liver transplantation[J]. J Vasc Interv Radiol, 2017, 28(2): 269-275. DOI: 10.1016/j.jvir.2016.06.029.
    [22] BREGUET R, DONDERO F, PUPULIM L, et al. Endovascular treatment of arterial complications after liver transplantation: long-term follow-up evaluated on Doppler ultrasound and magnetic resonance cholangiopancreatography[J]. Cardiovasc Intervent Radiol, 2019, 42(3): 381-388. DOI: 10.1007/s00270-018-2108-8.
    [23] CARRILLO-MARTÍNEZ MÁ, RODRÍGUEZMONTALVO C, FLORES-VILLABA E, et al. Catheter directed hepatic artery thrombolysis following liver transplantation. case report and review of the literature [J]. BJR Case Rep, 2019, 5(3): 20190005. DOI: 10.1259/ bjrcr.20190005.
    [24] RICCI K, ASHARF EH. The use of splenic artery embolization to maintain adequate hepatic arterial inflow after hepatic artery thrombosis in a split liver transplant recipient[J]. Int J Surg Case Rep, 2018, 51:241-243. DOI: 10.1016/j.ijscr.2018.09.003.
    [25] LI C, KAPOOR B, MOON E, et al. Current understanding and management of splenic steal syndrome after liver transplant: a systematic review[J]. Transplant Rev (Orlando), 2017, 31(3):188-192. DOI: 10.1016/j.trre.2017.02.002.
  • 加载中
图(1) / 表(1)
计量
  • 文章访问数:  472
  • HTML全文浏览量:  118
  • PDF下载量:  18
  • 被引次数: 0
出版历程
  • 收稿日期:  2020-06-15
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2020-09-15

目录

    /

    返回文章
    返回