原位肝移植术后门静脉并发症的诊治

Portal vein complications after orthotopic liver transplantation： a report of 6 cases

目的探讨原位肝移植术后门静脉并发症的诊断和治疗。方法回顾性分析173例原位肝移植患者的临床资料。结果本组原位肝移植术后有6例门静脉并发症（3．5％），门静脉狭窄发生率为1．2％，门静脉血栓发生率为2．3％，且术前3例有门静脉血栓，3例有门静脉高压症手术史。2例患者成功放置血管内支架，3例患者行套扎术或硬化剂治疗后好转出院，6例中无1例死亡。结论术前存在门静脉高压症手术治疗史和门静脉血栓是门静脉并发症的高危因素。彩色多普勒超声检查是监测门静脉并发症的有效方法，确诊门静脉并发症则要依据门静脉CT血管成像。晚期门静脉血栓溶栓治疗效果不佳，对单纯性门静脉狭窄行介入治疗是安全可行的。

Objective To study the diagnosis and treatment of portal vein complications after orthotopic liver transplantation. Methods The clinical data of 173 patients receiving orthotopic liver transplantation in our hospital from 2002 to 2005 were retrospectively analyzed. Results The incidence of portal vein complications was 3.5% （6 cases）. The incidence of portal vein stenosis was 1.2% and that of portal vein thrombosis was 2. 3%. Three cases had previously been treated for portal hypertension and three cases had had a history of portal vein thrombosis before liver transplantation. All the complicated patients recovered and were discharged after successful treatment. There was no complication related mortality. Conclusions A history of previous treatment for portal hypertension, portal vein thrombosis is a risk factor predisposing the patients to portal vein complications after orthotopic liver transplantation. Color Doppler sonography is a sensitive and specific method for monitoring the portal vein complications following orthotopic liver transplantation. The angiography of portal vein is essential for diagnosis of the complications. Thrombolysis treatment is unsatisfactory for advanced stage portal vein thrombosis. Balloon dilation and stenting are both a safe and effective management modality for simple portal vein stenosis.