77例肝移植门静脉血栓处理经验

Management experience of portal vein thrombosis in 77 liver transplantation cases

目的探讨肝移植术中门静脉血栓的处理方法及其对肝移植疗效的影响。方法回顾性分析598例次肝移植临床资料,77例(占12.9%)患者有门静脉血栓,其中39例系Ⅰ级,24例系Ⅱ级,12例系Ⅲ级,2例系Ⅳ级。对Ⅰ,Ⅱ级的门静脉血栓患者施行血栓切除或取栓术;Ⅲ级血栓患者采用取栓术或肠系膜上静脉架桥的方式重建供肝门静脉;对Ⅳ级血栓采用改良的门腔静脉半转流术。结果Ⅰ,Ⅱ级血栓组移植肝功能恢复良好,围手术期死亡率为6.3%(4/63),Ⅲ级血栓组取栓5例肝功能恢复良好,围手术期无死亡(0/5),静脉架桥组7例中有2例肝功能恢复不佳,围手术期死亡率为28.6%(2/7),Ⅳ级血栓组肝功能恢复良好,围手术期无死亡(0/2)。结论门静脉血栓已非肝移植的禁忌证,根据血栓的不同情况采取合理的手术方式可以使患者获得良好的治疗效果。

Objective To investigate the surgical options for the management of portal vein thrombosis （PVT） during liver transplantation and its impact on the outcome of patients. Methods 598 eases of liver transplantation were analyzed retrospectively. PVT occurred in 77 patients, including 39 of grade Ⅰ, 24 of grade Ⅱ, 12 of grade Ⅲ and 2 of grade Ⅳ. Simple thrombectomy or thrombus-extraction was performed in grade Ⅰ and Ⅱ. 12 patients with grade Ⅲ received thrombus-extraction or using the donor iliac vein to act as a bridge, between the donor portal vein and host superior mesenteric vein. Two cases of grade Ⅳ received a modified cavo-pertal hemitransposition. Results Liver function had a good recover and the perioperative mortality was 6.3%（4/63）in grade Ⅰ and Ⅱ. In grade Ⅲ, 5 cases received thrombus-extraction had a normal liver function after transplantation and no death was found perioperatively （0/5）. 2 cases among the other 7 cases using portal vein reconstruction had bad liver function and died. The liver function recovered well after transplantation and there was no death in grade Ⅳ. Conclusion PVT is not a contraindication for liver transplantation. Good results can be obtained by applying reasonable operative procedures individually.