儿童肝移植术后急性肝动脉血栓的治疗

Treatment for hepatic artery thrombosis after pediatric liver transplantation

目的探讨儿童肝移植术后急性肝动脉血栓(HAT)形成的诊断与治疗,及其对患儿预后的影响。方法自2012年1月至2013年8月天津市第一中心医院肝移植术后急性HAT患儿3例,2例患儿行肝动脉重新吻合及取栓治疗;1例行动脉内溶栓、经皮腔内血管成形术(PTA)及支架治疗。对患者临床资料、影像随访资料、介入治疗的并发症和预后等情况进行总结。结果 3例肝移植患儿出现急性HAT形成,均经血管造影证实,发生时间分别为术后第2天、第6天和第10天。2例患儿行肝动脉重新吻合及取栓手术,其中1例出现肝脓肿,经穿刺引流治愈;另1例患儿未出现并发症。1例患儿行肝动脉内溶栓、球囊扩张和内支架治疗;术后3个月出现缺血性胆管并发症,经T管窦道网篮取胆泥和置管治疗。随访所有患儿肝功能正常,超声示肝动脉血流通畅。结论肝移植术后常规超声监测肝动脉血流是早期发现HAT的关键,肝动脉造影可明确诊断;及时采用介入治疗、手术治疗可减少患儿及移植物失功能。

Objective To evaluate the diagnosis and treatment of hepatic artery thrombosis(HAT)after pediatric liver transplantation. Methods From January 2012 to August 2013,there were 3 children with HAT. 1 patient experienced interventional therapy with thrombolysis,percutaneous transluminal angioplasty(PTA)and stent. 2 patients underwent emergent hepatic artery revascularization combined with intra-arterial embolectomy. The therapeutic results were monitored by clinical follow-up and imaging examination. Results 3 children developed HAT on 2,6 and 10 days after operation,respectively. 2 children underwent emergent operation;1 child developed hepatic abscess and cured by puncture drainage;another child didn't experience any complications. 1 patient who performed interventional therapy,appeared ischemic biliary complications in 3 months after operation,and was treated with basket catheter from T-tube approach and drainage tube. All children were with normal liver function, hepatic artery patency on ultrasound. Conclusions It is essential to diagnose HAT by monitoring the artery flow by Doppler ultrasound screening in the early period after operation. Interventional therapy and emergent hepatic artery revascularization are effective rescue treatments.