介入治疗肝移植术后门静脉狭窄38例疗效分析

Interventional treatment of post-transplantation portal vein stenosis., a study of 38 cases

目的探讨介入治疗肝移植术后门静脉狭窄的价值。方法回顾性分析2005年1月至2013年3月于本院行肝脏移植术后发生门静脉狭窄并接受介入治疗的38例患者资料。所有患者均采用介入手段治疗。介入治疗后再次造影如发现胃冠状静脉仍明显扩张且影响门静脉血流，则以弹簧圈栓塞。总结临床资料、影像随访资料、介入治疗的并发症和预后等情况。结果38例患者介入治疗的技术成功率为100％。共置人自膨式支架7枚、球囊扩张式支架29枚，覆膜支架1枚。对2例小儿肝移植患者单纯采用球囊扩张成形术治疗。共有2例患者介入治疗后胃冠状静脉明显扩张且影响门静脉血流，予以栓塞治疗。随访3～90个月。介入治疗后发生肝内血肿1例，发生率为2．63％。1例因同时合并肝动脉闭塞、缺血性胆道损伤于术后3个月死于多脏器功能衰竭。因胆道并发症接受三次肝移植1例；因门静脉主干内癌栓形成再次置入覆膜支架1例；发生支架内再狭窄1例。其余34例患者影像随访显示门静脉通畅。结论肝移植术后门静脉狭窄采用介入治疗安全、有效，远期疗效良好。

Objective To evaluate the therapeutic results of percutaneous transhepatic stent an- gioplasty in patients with portal vein stenosis following liver transplantation. Methods From 2005 to 2013, 38 patients developed portal vein stenosis following liver transplantation. Percutaneous transhe- patic angioplasty of the portal vein stenosis was performed on these patients. The results were moni tored by clinical follow up and imaging studies. Results Percutaneous transhepatic angioplasty was successful in these patients. Self-expanding metallic stents （n=7）, balloon-expandable coronary stent （n= 29）, and membranous stent （n= 1） were used. The follow-up period ranged from 3 to 90 months. Portal venous patency was maintained in 34 patients （one patient died due to multi organ fail- ure, 1 patient accepted a third liver transplantation because of biliary tract complication, and 1 patient received a repeat placement of a membranous tent because the portal vein stent was blocked by a tumor thrombus, and 1 patient developed stent restenosis）. There was 1 patient who developed hemorrhage in the early postoperative period （2.63 %）. A diagnosis of hepatic artery hemorrhage was made by he- patic artery angiography and the patient was treated by interventional embolization. Conclusion Per- cutaneous transhepatic stent angioplasty is an efficacious and safe method to treat portal vein stenosis following liver transplantation.