肝移植术后并发症与介入治疗 五、腔静脉、肝静脉梗阻

Interventional therapy and complications after liver transplantation:the obstruction of the hepatic vein and inferior vena cava

肝移植术后肝静脉、腔静脉梗阻的发生率很低,术后急性发生常与手术技术因素有关,较晚发生常因为吻合口内膜增生与纤维组织瘢痕生成所致。一般临床表现包括移植肝失功能、肝淤血、腹水、腹痛等。腔内球囊扩张术与支架植入安全、有效,可以获得长期的血管开通。球囊成形术技术成功率高,但容易再狭窄,对于成人或肝静脉具有成人腔径的儿童患者,支架效果更好。

The occurrence rate of the obstruction of the hepatic vein or the inferior vena cava is very low. Obstruction can develop acutely as a result of technical problems or can present itself much later after the transplantation due to intimal hyperplasia or perianastomotic fibrosis. Clinically, the common presentations include hepatic dysfunction, liver engorgement, ascites, abdominal pain, etc. Percutaneous endovaseular treatment with balloon dilation or stent placement is a safe and effective alternative treatment, which can keep the vessels open for a long period of time. Angioplasty can achieve technical success in restoring anastomotie pateney almost to 100% of cases, but, unfortunately, restenosis occurs frequently. For adult patients or pediatrie patients with adult-sized hepatic veins, stenting seems to be the optimal choice.