介入放射技术在肝移植术后肝动脉并发症中的应用

The application of interventional radiological procedures in treating hepatic artery complications occurred after liver transplantation

目的探讨介入放射技术在肝移植术后肝动脉并发症诊治中的应用价值。方法对13例肝移植术后出现肝动脉并发症患者进行介入治疗。对6例肝动脉狭窄(HAS)者采用PTA或支架植入治疗,3例肝动脉闭塞者先行动脉开通,再行PTA或支架治疗,3例肝动脉血栓形成(HAT)者行经导管溶栓治疗,1例胃十二指肠动脉盗血综合征(GSS)者行胃十二指肠动脉弹簧圈栓塞治疗。观察即刻、近期及远期疗效。结果即刻疗效的总有效率为84.6%(11/13)。其中HAS的有效率为6/6,HAT为3/3,GSS为1/1,肝动脉闭塞为1/3。近期疗效观察(彩色多普勒超声)未见肝动脉血流减少或消失,术后3 d丙氨酸转氨酶(t=2.68,P<0.05)和总胆红素(t=2.94,P<0.05)显著下降。随访2～34个月,无肝动脉并发症发生,未出现介入治疗相关并发症和死亡。结论采用介入放射技术处理肝移植术后肝动脉并发症安全、有效、创伤小,可作为首选的治疗方法。

Objective To evaluate the interventional radiological procedures in treating hepatic artery complications occurred after liver transplantation.Methods Thirteen patients with hepatic artery complications occurred after liver transplantation received interventional treatment.The interventional procedures included（1） percutaneous transarterial angioplasty（PTA） or endovascular stenting（ES） for 6 patients with hepatic artery stenosis（HAS） and for 3 patients with hepatic artery occlusion;（2） catheter-directed thrombolysis for 3 patients with hepatic artery thrombosis（HAT） and（3） coil embolization for one patient with gastroduodenal steal syndrome（GSS）.Immediate,short-term and long-term effects were observed and evaluated.Results The general immediate effective rate was 84.62%（11/13）.The effective rate was 100% for HAS（6/6）,HAT（3/3） and GSS（1/1）.However,the effective rate for hepatic artery occlusion was only 33.3%（1/3）.Color Doppler ultrasonography showed that the hepatic arterial flow remained fluent.Three days after the treatment statistically significant decrease in ALT（t = 2.68,P〈0.050） and T-BIL（t =2.94,P〈0.05） was observed.No procedure-related complications or death occurred during the follow-up period of 2 ～ 34 months.Conclusion As a safe,effective and minimally-invasive technique,interventional management can be regarded as the treatment of first choice for hepatic artery complications occurred after liver transplantation.