原位肝移植后血管并发症的血管腔内介入治疗

Endovascular Interventional Treatment of Vascular Complication after Orthotopic Liver Transplantation

目的分析总结血管腔内介入治疗在原位肝移植后血管并发症中的作用和意义。资料与方法回顾性分析31例原位肝移植术后血管并发症患者的血管腔内介入治疗资料与随访结果。结果31例患者中单纯肝动脉并发症11例,门静脉并发症11例,腔静脉并发症6例,合并肝动脉与门静脉并发症1例,合并腔静脉、肝静脉、门静脉复杂并发症1例,脾动脉窃血综合征1例。均成功进行了血管腔内介入治疗。共置入肝动脉支架13枚,静脉支架21枚,进行肝动脉栓塞1例,部分性脾动脉栓塞2例,单纯腔静脉球囊扩张1例,1例患者肝动脉局部灌注溶栓后置入肝动脉支架,1例患者先后置入腔静脉、肝静脉与门静脉支架各1枚,1例患者同时置入门静脉和肠系膜上静脉支架。所有血管腔内介入操作成功有效,技术成功率100%,手术相关并发症发生率12.9%,并且并发症经处理无后继影响。随访中除1例肝动脉于支架置入后19天发生再狭窄外,其余血管至随访结束未出现明确再狭窄。结论肝移植术后血管并发症的血管腔内介入治疗安全有效,技术成功率高而并发症发生率低,是一种理想的微创治疗选择。

Objective To evaluate the role of endovascular interventional treatment in vascular complications after orthotopic liver transplantation. Materials and Methods A retrospective review and analysis was performed in data of all 31 patients, who underwent endovascular interventional treatment of vascular complications after orthotopic liver transplantation. Results There were 11 patients with only hepatic artery complications, 11 with portal vein stenosis, 6 with inferior vena cave stenosis, 1 with both hepatic artery and portal vein stenosis, 1 with stenosis in inferior vena cave, hepatic vein and portal vein, 1 with spleen artery steal syndrome. All cases underwent successful endovascular interventional treatment in our department. A total 13 stents were used for hepatic arteries and 21 for veins. Hepatic artery embolization was performed in 1 patient and partial spleen artery embolization was performed in 2.1 patient with inferior vena cave stenosis was treated with balloon dilation alone. The patient with hepatic artery thrombosis was treated with stentt after successful thrombolysis. 2 patients with more than one vascular involved were treated with several stentts respectively. The technique success rate was 100%, with complication rate of 12.9% and no severe consequences. No restenosis was occurred except one hepatic artery developed restenosis at nineteenth day after stenting. Conclusion Endovascular interventional treatment is effective and safety in the management of vascular complications after orthotopic liver transplantation.