肝移植术后肝动脉血栓的处理及预后

Treatment and prognosis of hepatic artery thrombosis after liver transplantation

目的了解肝移植术后肝动脉血栓(HAT)的处理方法及预后。方法收集2004年至2010年在北京佑安医院肝移植中心施行的427例肝移植病例的临床资料,分析HAT的临床处理方法及预后情况。结果 427例肝移植患者中,共发生HAT5例(1.2%),发生时间为4～91d(中位时间28d)。经尿激酶介入溶栓、血栓取出、肝动脉重建、再次肝移植及高压氧等治疗后,5例患者中死亡3例。移植物存活时间为8～690d(中位时间298d),患者存活时间为13～1005d(中位时间298d)。结论肝移植术后HAT发生率较低,但预后极差。一旦确诊及时采用尿激酶介入溶栓、血栓取出、肝动脉重建、再次肝移植及高压氧等治疗,以降低病死率。

Objective To investigate the treatment and the prognosis of hepatic artery thrombosis（HAT）after liver transplantation（LT）.Methods Clinical data of 427 patients after LT from 2004 to 2010 in liver transplantation center of Beijing YouAn Hospital were retrospectively collected and analyzed to investigate the treatment measures and prognosis.Results HAT occurred in five patients（1.2 %）at 4 d to 91 d after LT（median time 28 d）.Interventional thrombolytic therapy with urokinase,thrombectomy,hepatic artery reconstruction,re-transplantation and hyperbaric oxygen were performed.Three of the five patients died.The median survival time of grafts was 298 d（ranging from 8 d to 690 d）after the first LT and the median survival time of patients was also 298 d（ranging from 13 d to 1 005 d）.Conclusions The incidence of HAT was very low,but the clinical prognosis is very poor.It is necessary to reduce the mortality of HAT by using interventional thrombolytic therapy,thrombectomy,hepatic artery reconstruction,re-transplantation and hyperbaric oxygen treatment when HAT occurs after LT.