成人肝移植术后肝动脉并发症的介入治疗疗效分析

Outcome of interventional treatment of hepatic artery complications after adult liver transplantation

目的探讨肝移植(LT)术后肝动脉并发症血管内介入治疗的安全性和有效性。方法回顾性分析2010年1月~2015年2月我院12例肝移植术后经影像学证实的肝动脉并发症的临床资料。包括肝动脉血栓形成(HAT)5例,肝动脉狭窄(HAS)3例,HAS合并HAT 2例,肝动脉假性动脉瘤(HAP)合并HAS 2例,对肝动脉血栓形成、肝动脉狭窄程度超过50%及肝动脉假性动脉瘤形成者行介入治疗。结果成功治疗10例,技术包括导管内溶栓(CDT),经皮腔内血管成形术(PTA)及支架植入术(stent placement),技术成功率83%(10/12)。1例在PTA过程中破裂,成功植入覆膜支架,1例在溶栓过程中出现少量出血,经保守治疗后好转。术后两周血清丙氨酸氨基转氨酶(ALT)、天门冬氨酸氨基转氨酶(AST)、总胆红素(TBil)及直接胆红素(DBil)明显降低(P<0.01)。随访2~24个月,2例因术后再狭窄和急性血栓形成再次介入治疗,余患者未出现介入相关并发症。结论血管内介入治疗可作为肝移植术后肝动脉并发症的一线治疗方法。

Objective To analyze the safety and efficacy of endovascular interventional treatment of hepatic artery complications after liver transplantation. Methods The outcome of 12 patients who underwent endovascular interventional treatment from January 2010 to February 2015 was reviewed. Endovascular interventional therapy was used to treat hepatic artery thrombosis（5） with（2）or without（3） hepatic artery stenosis, and hepatic artery pseudoaneurysm with hepatic artery stenosis（2）. Results 10 patients were successfully treated using catheter-directed thrombolysis（CDT）, percutaneous transluminal angioplasty（PTA）, and stent placement.Primary technical success rate was 83%（10/12）. Rupture and bleeding of the hepatic artery occurred during PTA in one patient and were successfully treated with graft-covered stent. Minimal bleeding during CDT in one patient was successfully treated with conservative methods. Serum alanine aminotransferase, aspartate aminotransferase, total bilirubin and direct bilirubin decreased significantly（P〈0.01） two weeks after treatment. All patients were followed up for 2-24 months. Two patients underwent repeated treatment because of restenosis and acute thrombosis. No complications related to interventional treatment were observed in the remaining patients. Conclusion Endovascular interventional treatment can be used as first-line treatment for hepatic artery complications after liver transplantation.