肝移植术后肝动脉病变的介入治疗的临床应用价值

Application value of interventional therapy for hepatic artery complications after liver transplantation

目的:评价介入治疗在肝移植术后肝动脉并发症治疗中的价值及疗效。方法:回顾性分析2006年1月—2012年1月期间49例怀疑肝移植术后肝动脉并发症的患者的诊断与治疗以及随访资料。结果:肝动脉造影共检出肝动脉并发症26例。肝动脉狭窄21例,其中6例轻中度狭窄未处理;15例为重度狭窄给予肝动脉支架置入术,3例随访期间发现支架再狭窄。假性动脉瘤形成2例,其中1例行覆膜支架置入术,封堵良好;1例行支架辅助弹簧圈栓塞术,复查造影显示肝动脉闭塞,随访期至1.5个月时出现广泛胆道坏死,行经皮肝穿胆汁引流术。肝动脉血栓形成3例,其中1例溶栓后随访23个月未出现血栓形成;1例动脉溶栓效果不佳者,介入治疗3 d后接受了二次肝移植术;1例肝动脉闭塞但侧支循环已建立未给予治疗。结论:介入治疗能有效地解除肝移植术后多种肝动脉并发症,在保证肝移植手术成功、延长患者生存方面具有一定的应用价值。

Objective： To assess the application value and effcacy of interventional therapy for hepatic artery complications after liver transplantation. Methods： The diagnosis and treatment as well as the follow-up data of 49 patients with suspicious hepatic artery complications at er liver transplantation during January 2006 to January 2012 were retrospectively analyzed. Results： Hepatic artery complications were detected in 26 patients by hepatic arteriography. Hepatic artery stenosis was found in 21 patients, of whom 6 cases with mild and moderate stenosis underwent no treatment; 15 cases with severe stenosis underwent hepatic artery stent placement and intra-stent restenosis developed in3 of them during follow-up. Pseudoaneurysm formation was found in 2 patients, of whom one case underwent covered stent placement and the aneurysm was completely occluded; one case developed hepatic artery occlusion after undergoing stent-assisted coil embolization, and extensive biliary necrosis occurred at 1.5 months of followup, and then underwent percutaneous transhepatic biliary drainage. Hepatic artery thrombosis was found in 3 patients, of whom one case received transcatheter thrombolysis and no thrombosis formation was observed during 23 months of follow-up; one case with ineffective thrombolysis underwent a second liver transplantation 3 d at er interventional treatment; one case with hepatic artery occlusion did not undergo treatment because the collateral circulation was established.Conclusion： Interventional therapy can effectively deal with various hepatic artery complications after liver transplantation and has certain application value in ensuring the success of liver transplantation and improving the survival of the patients.