肝移植术后肝动脉狭窄的诊断和治疗

Hepatic Artery Stenosis after Liver Transplantation:diagnosis and Treatment

目的：总结肝移植术后肝动脉狭窄的诊治经验。方法：回顾性总结１０６例１０７次肝移植病人的３例肝动脉狭窄的临床资料，结合文献分析了肝动脉狭窄的高危因素及其对肝移植的影响。结果：本组肝动脉狭窄的发生率为２．８％。３例均经彩超检查诊断和肝动脉造影确诊。例１狭窄位于受体肝总动脉起始处，放置血管内支架后血流恢复正常，但术后第１８天死于肝功能衰竭；例２狭窄位于吻合口，不能通过导丝而未行介入治疗，但病人无症状，肝功能良好；例３狭窄位于吻合口近端，经肝动脉重建后血流恢复正常。结论：肝动脉狭窄的早期诊断和及时治疗非常关键，其对移植肝的影响取决于当时的肝功能状态。纠正肝动脉狭窄有助于预防胆道并发症和提高移植物的存活率。

Objective:To sum up the experience in the diagnosis and treatment of hepatic artery stenosis(HAS) after liver transplantation. Methods:Over a 8-year period, 107 orthotopic liver transplants were performed in 106 patients. The clinical data of 3 cases with HAS were reviewed. Risk factors in the development of HAS and the impact on the outcome of grafts were analyzed. Results:The incidence of HAS in our group was 2.8%, 3 cases were diagnosed by colour ultrasonography and then confirmed by arteriography. Stenosis was located at the origin of HA in the first patient; HA flow was restored to normal after placing an intraarterial metallic stent but the patient died of hepatic failure on Day 18. Anastomotic stenosis was identified in the second case; a guidewire could not be passed through the lesion during angiography, but patient remained asymptomatic with good biochemical liver function. In the third case, the stenosis was in the recipient HA, proximal to the anastomosis; HA flow was restored to normal after arterial reconstruction.Conclusions:Early identification and timely management of HAS are critical; the impact on the outcome of transplantation depends on the state of liver function by that time. Revision of HAS may help to prevent biliary complications and to improve the survival rate.