门静脉血栓的肝移植术中处理

Surgical treatment for portal vein thrombosis in patients undergoing liver transplantation

目的探讨门静脉血栓（PVT）的肝移植术中外科处理方法及其效果。方法肝移植患者2508例，共行肝移植2614次，其中253例术前并发PVT。并发PVT者的Yerdel分级为，I级者104例，Ⅱ级者114例，Ⅲ级者29例，Ⅳ级者6例。根据具体情况对并发I、Ⅱ级PVT者施行静脉血栓切除术、外翻血栓切除术或外翻式门静脉内膜剥脱切除术；并发Ⅲ级PVT者，18例行外翻式门静脉内膜剥脱切除术，11例行外翻血栓切除术；并发Ⅳ级PVT者行外翻式门静脉内膜剥脱切除术。结果218例并发I、Ⅱ级PVT者中，32例行静脉血栓切除术，52例行外翻血栓切除术，134例行外翻式门静脉内膜剥脱切除术，均获得成功。29例并发Ⅲ级PVT者中，18例行外翻式门静脉内膜剥脱切除术，均获得成功；11例行外翻血栓切除术，其中5例获得成功，6例失败。6例并发Ⅳ级PVT者中，3例行外翻式门静脉内膜剥脱切除术，获得成功，3例取栓失败。253例并发PVT者肝移植术后6个月的存活率为93．7％，与同期无PVT的肝移植患者相比较（94．4％），差异无统计学意义（P〉0．05）。结论并发PVT者可接受肝移植，术中应根据PVT的Yerdel分级情况，采取适合的外科处理方式。

Objective To discuss the surgical treatment of portal vein thrombosis （PVT） in liver transplantation and the curative effectiveness. Methods In 2508 cases of liver transplantation （2614 times）,253 cases were complicated with preoperative PVT, and there were 104, 114,29 and 6 cases of PVT Yerdel grade Ⅰ , Ⅱ , Ⅲ and Ⅳ respectively. The patients with PVT of grade Ⅰ and Ⅱ , simple thrombectomy, thrombus-extraction or combined intima of portal vein and thrombus-extraction operation were performed. Eighteen patients of grade Ⅲ received combined intima of portal vein and thrombus-extraction operation, and 11 received thrombus-extraction operation. Six patients of grade IV were subjected to combined intima of portal vein and thrombus-extraetion operation. Results Among 218 PVT patients of grade Ⅰ and Ⅱ ,32 received venous thrombectomy, 52 thrombus-extraetion and 134 combined intima of portal vein and thrombus-extraction operation, and success rate was 100 %. Among 29 PVT patients of grade Ⅲ, 18 received combined intima of portal vein and thrombus- extraction operation （100 % success rate） ,and 11 thrombus-extraction （5 cases were successful, and 6 failed）. Six PVT patients of grade IV, received combined intima of portal vein and thrombus-extraction operation （3 cases were successful, and 3 cases failed）. The 6-month survival rate of PVT patients after surgical operation was 93. 7%, and that of non-PVT patients 94. 4% （P〉0. 05）. Conclusion Liver transplantation could be adopted on PVT patients regarding to different Yerdel grades.