活体供肝者术后门静脉血栓形成的诊治二例

Diagnosis and treatment of 2 cases of portal vein thrombosis after hepatectomy in living donors

目的总结活体供肝者术后门静脉血栓形成的诊治体会。方法2名活体供肝者，术前螺旋CT评估门静脉分型为B型门静脉和A型门静脉，经估算，残肝体积分别为全肝体积的33％和36％，均切取带肝中静脉的右半肝。术后早期丙氨酸转氨酶（ALT）和总胆红素升高，腹腔引流液较多，呈腹水样，超声波检查提示门静脉血栓形成，并经增强螺旋CT明确诊断。供者1急诊行探查术，阻断门静脉血流，拆除闭合残端缝线，将门静脉切断，切除狭窄处门静脉壁，开放门静脉主干，取出多块新鲜血栓，用肝素盐水冲洗至血流通畅后，再将其端端吻合，恢复血流。供者2给予抗凝和溶栓治疗。结果供者1在手术探查后再次发生门静脉血栓形成，经抗凝和溶栓治疗后血栓消失，痊愈出院。供者2经保守治疗后血栓消失，痊愈出院。结论门静脉血栓形成可依据超声波及CT等影像学检查结果作出诊断，可采取手术取栓或抗凝、溶栓治疗。

Objective To summarize the experience in the diagnosis and treatment of portal vein thrombosis after hepatectomy in living donors. Methods Two living donors, with portal vein type B and type A respectively after precisely preoperative Computer Tomography evaluation, were subjected to right lobe hepatectomy which contained middle hepatic vein, and the remnant liver volume to total liver volume ratio were 33 % and 36 %. During early period after operation, liver function test showed elevated alanine aminotransferase and total bilirubin, and increased ascites-like abdominal fluid drainage. Ultrasound examination revealed portal vein thrombus formation which definitely diagnosed by contrast enhanced computed tomography. The donor 1 received emergency exploratory laparotomy, portal vein blood flow was blocked, the portal vein stump suture was removed, the partial stricture segment was resected, the thrombi were taken out, the portal vein cavity was flushed thoroughly by heparin-containing solution, and portal vein blood flow recovered after reanastomosis. The donor 2 underwent anticoagulation and thrombolysis treatment. Results In the donor 1, portal vein thrombosis reoccurred~ after exploratory operation. After anticoagulative and thrombolysis treatment, the portal vein thrombi disappeared and the donor recovered. The donor 2 was cured by anticoagulation treatment. Conclusion Portal vein thrombosis after hepatectomy in living donor can be diagnosed by ultrasound and contrast enhanced computed tomography. Once portal vein thrombosis identified, operation or thrombolysis treatment should be performed immediately.