支架置入治疗肝移植术后肝动脉狭窄的初步临床观察

Feasibility and efficacy of stent placement in the treatment of hepatic artery stenosis after liver transplantation

目的探讨支架置入治疗肝移植术后肝动脉狭窄(HAS)的可行性及临床效果。方法回顾性分析13例肝移植术后经肝动脉造影证实、并行肝动脉支架置入(12例)或经皮腔内血管成形术(PTA)治疗(1例)的 HAS 患者的临床资料及支架置入技术要点。结果 13例患者中,11例成功置入支架,1例 PTA 加支架置入失败,1例单纯 PTA 治疗成功。支架术后随访9～227 d,平均97 d,无一例术后发生支架内再狭窄。诊疗时距在2周内的7例患者,1例支架置入术后9 d 死于多器官功能衰竭,6例术后血清转氨酶和(或)胆红素恢复正常;而诊疗时距大于2周的4例患者,1例死于胆道感染引起的败血症和肝功能衰竭,3例血清胆红素仍高于正常、反复出现胆道感染,经抗感染和(或)胆道引流病情好转。结论支架治疗肝移植术后 HAS 是可行的,指引导管或长鞘技术和冠状动脉支架的应用可提高支架置入技术的成功率。早期诊断、早期治疗是影响支架置入疗效的关键因素。

Objective To evaluate the feasibility and efficacy of stent placement for the treatment of hepatic artery stenosis （HAS） after liver transplantation. Methods Thirteen patients were proved to be HAS by angiography after liver transplantation. Twelve of them were treated with stem placement, 1 patient only received percutaneous transluminal angioplasty （PTA）. Stent placement techniques and the clinical data of 13 cases were retrospectively analyzed. Results Among 13 patients with HAS, 11 patients were successfully treated with stent placement. During 9-227 days of follow-up （ mean, 97 days）, no intrastent restenosis was found by Doppler sonography. In 7 patients with less than 2 weeks diagnosis-therapy intervals, the elevated liver enzyme and/or bilirubin became normal after stem placement in 6 patients except 1 patient died of multiple organ failure at 9 days after the procedure; while in 4 patients with more than 2 weeks diagnosis-therapy intervals, 1 patient died of septicemia due to repeated bile duct infection and liver function failure, the other 3 patients still had repeated bile duct infection, which was improved after endoscopic retrograde cholangiopancreatography （ERCP） and drainage. Conclusion Stent placement for HAS after hver transplantation is feasible. Catheter-sheath and coronary artery stents can be used to improve stent placement success. Early diagnosis and therapy are the critical factors for the efficacy of stent placement.