术前门静脉血栓对活体肝移植预后的影响

The impact of preoperative portal vein thrombosis on living donor liver transplantation

目的探讨术前门静脉血栓对活体肝移植的影响。方法回顾性分析天津市第一中心医院2007至2011年完成的99例成人间活体肝移植患者，根据术前是否有门静脉血栓分为2组，血栓组26例，无血栓组73例。比较2组的术前危险因素及门静脉血栓对活体肝移植手术和术后患者预后的影响。结果26例门静脉血栓患者Ⅰ级血栓23例，Ⅱ级血栓3例。肝移植术前的脾切除是发生门静脉血栓的独立危险因素（χ2=10．211，P=0．001）。术前门静脉血栓会延长手术的无肝期（Z=-2．430，P=0．015），但2组患者术后并发症发生率（χ2=0．326，P=0．568）及死亡率均无统计学差异，而且对患者的1年生存率和3年生存率均无影响（χ2=0．505，P=0．477）。结论对于活体肝移植合并Ⅰ级或Ⅱ级门静脉血栓的患者，通过合理的术中处理及术后预防，门静脉血栓不会影响患者的预后。但门静脉血栓增加了一定的手术难度，需要详尽的术前评估和仔细的术中操作。

Objective To investigate the impact of preoperative portal vein thrombosis （PPVT） on living donor liver transplantation （LDLT）. Methods In this study, 99 patients who underwent LDLT by the same surgical team of Tianjin First Centre Hospital from 2007 to 2011 were retrospectively analyzed. According to whether there was a PPVT, all the patients were divided into PPVT group （26 cases） and non- PPVT group （73 cases）. The preoperative risk factors and the impact of PPVT on LDLT and outcomes were analyzed. Results Among 26 PPVT patients there were 23 cases in grade Ⅰ and 3 cases in grade Ⅱ. Splenectorny was found to be an independent risk factor for PPVT （ χ2 = 10. 211, P = 0. 001 ）. PPVT prolonged the anhepatic phase （Z = - 2. 430, P = 0. 015） , but the incidence of surical complications and mortality were no statistical differences between the PVT group and the non-PVT groups. Meanwhile, there was no statistical difference of 1-and 3-year survival rate between the two groups（ χ2 = 0, 505, P = 0. 477 ）. Conclusions With proper intraoperative treatment and postoperative prevention, PPVT does not affect the outcomes of patients suffering from grade Ⅰ or Ⅱ PPVT. However, PPVT added to difficulties of operation, so the detailed preoperative evaluation and careful intraoperative operation is necessary.