肝移植术后肝动脉狭窄的治疗

TREATMENT OF HEPATIC ARTERY STCNOSIS AFTER ORTHOTOPIC LIVER TRANSPLANTATION

目的探讨肝移植术后肝动脉狭窄的治疗。方法连续503例肝移植中出现15例肝动脉狭窄,根据临床表现、动态肝功能和彩色多普勒检查、CT动脉成像、选择性肝动脉造影诊断。结果术后早期出现肝动脉狭窄10例,2例合并肝动脉血栓形成,再移植3例,介入治疗7例,其中动脉支架植入5例,球囊扩张溶术后6天肝功能衰竭死亡1例,支架植入术后9天肝功能衰竭死亡1例。1月后发现肝动脉狭窄5例,介入治疗均行肝动脉支架植入,1例支架植入术后186天因胆道感染死亡。结论根据肝动脉狭窄程度、发生时间、移植肝功能状态和病人情况选择治疗措施。再移植是治疗肝移植术后肝动脉狭窄的有效方法。肝动脉支架植入可挽救移植肝,改善移植肝功能,延长移植肝发挥功能以等再次肝移植。

Objective To evaluated the effct of percutaneous interventional management and retansplantation on hepatic artcry stenosis after orthotopic liver transplantation（OLT）. Methods Of 503 consecutive orthotopic liver transplant recipients between October 2003 and September 2005,15 presented with hepatic artery stenosis （HAS）,and it was diagnosed by the combination with clinical manifestation ,dynamical liver function tests and color Doppler imaging. CT angiography and digital subtraction angiography. Percutaneous interventional management included thrombolysis, oercutaneous transluminal angioplasty（PTA）and stent placement. Result Ten cases presented with hepatic artery stenosis in early postoperative stage, and 2 with hepatic artery thrimbsis. 3 paticnts recovered after retransplantation, 5 with percutaneous interventional managcment including stentin,and 1 with PTA and thrombolysis. 5 patients presented with delayed hepatic artery stenosis after 1 month postoperatively,were treated with pcrculaneous interventional management ,and all with stenting, 1 patient died of liver abscess and biliary infection at 186 days after stent placement. Conclusion Management to HAS should be based on the degree of HAS. the temporal relationship of the diagnosis to the management ,the graft function and the clinical condition. Retransplantation is the standard therapy for HAS. Percutaneous interventional management improves liver graft function , and allows allograft saving,at least until another suitable donor becomcs available.