肝移植术后早期门静脉血栓3例报告

THE TREATMENT OF EARLY PORTAL VEIN THROMBOSIS AFTER ORTHOTOPIC LIVER TRANSPLANTATION:3 CASES REPORT

目的总结肝移植术后早期门静脉血栓形成的原因及防治体会。方法回顾性分析肝移植术后早期门静脉血栓形成的3例病例资料,总结其血栓形成的原因、预后及诊治方案的经验和教训。结果 1例由于发现较晚未能及时有效地处理,虽然经手术取栓和全身抗凝治疗,仍未能避免移植肝的丢失,经再次肝移植治愈;1例虽经再次肝移植治疗,但由于患者一般情况差、并发症多,于再移植术后第35天死于严重的肺部真菌感染和多器官功能衰竭;1例在临床症状未出现前被彩色多普勒超声及时发现,经手术取栓及术后抗凝治疗后痊愈。结论肝移植术后早期门静脉血栓形成是一个可以导致移植肝丢失并且危及受体生命的严重并发症。保障有效的门静脉血流量、减少门腔分流、术后早期抗凝治疗是预防肝移植术后门静脉血栓发生的关键。通过术后密切的彩色多普勒超声监测对病变早期诊断并及时有效的外科处理是提高预后的有效措施。

Objective To investigate and summarize the reason and treatment of early portal vein thrombosis（PVT） after orthotopic liver transplantation（OLT）.Methods A retrospective study was performed on etiology,prognosis and treatment in 3 cases of early PVT after OLT.Results One case did not avoid the graft loss and undergo retransplantation after failure of surgical thrombectomy and anticoagulant therapy.One patient died of serious pulmonary fungal infection and multiple organ failure on 35th day following retransplantation.Benefiting from close monitoring with color Doppler ultrasonography（CDUS）,one case was treated successfully with prompt thrombectomy and anticoagulant therapy.Conclusion Early PVT after OLT is a life threatening complication associated with a high rate of graft loss and patient death.The key points of preventing early PVT after OLT include enough portal blood flow,decreasing portacaval shunt and early anticoagulant treatment after operation.Monitoring portal venous dynamics with CDUS and promptly surgical therapy are essential to improve prognosis of early PVT following OLT.