原位肝移植术后下腔静脉狭窄的诊治

Inferior vena cava stenosis after orthotopic liver transplantation: diagnosis and treatment

目的 总结原位肝移植术后下腔静脉狭窄的诊治经验。方法 总结 5 1例原位肝移植术后 3例下腔静脉狭窄的临床资料。结果 本组下腔静脉狭窄发生率为 5 8% (3/5 1) ,3例均为肝后段下腔静脉狭窄 ,均发生在术后 1个月内 ,均经超声检查及下腔静脉造影证实。经皮腔内腔静脉气囊扩张或放置内支架后 ,血流恢复通畅 ,下肢水肿消失。例 1术后第 14d死于脑出血 ;例 2和例 3恢复顺利 ,肝功能良好 ,现已分别存活 18个月、4个月。经彩超检查证实下腔静脉血流通畅。结论 经皮腔血管成形术及放置血管内支架治疗肝移植术后早期下腔静脉狭窄安全可靠 ,近期疗效满意。

Objective To report the experience in diagnosis and treatment of inferior vena cava stenosis (IVCS) after orthotopic liver transplantation (OLT). Methods The clnical data of 3 patients with IVCS out of 51 OLT patients were analysed retrospectively. Results The incidence of IVCS after OLT was 5.8% (3/51) in our hospital. In the 3 cases, IVCS of the posteriorhepatic IVC segment occurred within the first postoperative month. IVCS was identified by color duplex ultrasonography and confirmed by angiography. Percutaenous transluminal angioplasty (PTA) or metallic stent replacement were used in the 3 cases resulting in restoration of normal venous flow and elimination of legs edema. The first patient died of cerebral hemorrhage 14 days after transplantation during anti-coagulative therapy. The other two recovered smoothly with good liver function, abdominal ultrasonography demonstrated patency of the IVC. The 2 cases were alive for 18 and 4 months respectively. Conclusions The venacavographic balloon angioplasty and metallic stent replacement are safe and useful for post-OLT IVCS. The short-term result is excellent.