原位肝移植术后门静脉并发症处理及远期疗效评估

Treatment for portal venous complications after orthotopic liver transplantation and evaluation of longterm curative effect

目的 总结并评估原位肝移植术后并发门静脉并发症的处理及其远期疗效.方法 研究对象为2002年6月至2013年4月在上海交通大学附属第六医院收治的12例肝移植术后门静脉并发症患者.对12例患者的临床资料进行分析,分析内容包括并发症的发生时间、病变性质、术前病史、术后诊断经过、处理经过及远期疗效.结果 本组患者门静脉并发症发生时间为肝移植术后3～54个月.其中门静脉吻合口狭窄3例,门静脉系广泛血栓4例,门静脉主干血栓2例,门静脉和肠系膜上静脉附壁血栓3例.3例门静脉吻合口狭窄患者成功放置血管内支架;3例门静脉和肠系膜上静脉附壁血栓患者经溶栓和抗凝治疗无病情进展;余6例患者行套扎术或硬化剂治疗后好转出院.随访3年,12例中无1例死亡.结论 肝移植术后门静脉并发症的治疗方案取决于门静脉病变性质和程度.对于早期门静脉血栓或局部附壁血栓,溶栓治疗可取得满意效果;晚期门静脉血栓溶栓治疗效果不佳.对单纯性门静脉狭窄行介入治疗是安全可行的.肝移植术后门静脉并发症经及时处理后远期效果良好.

Objective To summarize and evaluate the long-term therapeutic effect of treatment for portal venous complications after orthotopic liver transplantation （OLT）. Methods Clinical data of 12 patients with portal venous complications after OLT in the Sixth People＇s Hospital of Shanghai Jiaotong University from June 2002 to April 2013 were analyzed. The occurrence time, the character of the lesions, the disease history before operation, the diagnostic process after operation, the process of treatment and long-term curative effect were analyzed. Results The occurrence time of portal venous complications was from 3 to 54 months after liver transplantation. Portal venous anastomotic stoma stenosis was found in 3 cases, extensive portal system thrombus in 4 cases, main portal vein thrombus in 2 cases, and portal vein and superior mesenteric vein mural thrombus in 3 cases. The stents were successfully placed in 3 patients with portal venous anastomotic stoma stenosis. No further development was found in the 3 patients with thrombus in portal vein or superior mesenteric vein mural thromus after thrombolysis and anti-coagulation. The other 6 patients relieved and were discharged from hospital after ligation and sclerotherapy. Patients were followed up for 3 years. No death was found in these 12 cases. Conclusions The therapeutic schedule for portal venous complications after OLT depends on the character of portal vein lesions and the level of pathological changes. Thrombolysis can achieve satisfactory effect in patients with early portal vein thrombus or partial mural thrombus, while the curative effect is poor for late stage portal vein thrombus. It is safe and feasible for patients with simple portal venous stenosis to receive interventional therapy. The long-term curative effect is good for patients with portal venous complications after OLT after timely treatments.