肝移植术中合并门静脉海绵样变者门静脉重建方式分析

Reconstruction method of portal vein in patients with cavernous transformation of portal vein during liver transplantation

目的探讨合并门静脉海绵样变(CTPV)者肝移植术中门静脉重建的方式及其疗效。方法抽取2012年1月至2020年1月河南省人民医院收治的合并CTPV行肝移植术的患者7例,6例患者行门静脉取栓-门静脉吻合术,其中1例行门静脉取栓-门静脉吻合术后出现门静脉血流不足,又联合实施了右肾静脉-门静脉端侧吻合术;1例患者行左肾静脉-门静脉端端吻合术。结果 7例患者术后均顺利出院。1例患者于术后40 d门静脉血栓形成,予以溶栓、抗凝治疗,仍再发CTPV;1例患者术后2年出现门静脉吻合口狭窄,术后4年再发CTPV。7例患者目前肝功能均良好,正常生活。结论合并CTPV者肝移植手术风险高,门静脉取栓-门静脉吻合、肾静脉-门静脉吻合均可取得满意门静脉重建效果,曾行脾切除者术后需加强抗凝和门静脉血流监测。

Objective To investigate the procedure and effects of portal vein reconstruction in liver transplantation for patients with cavernous transformation of portal vein(CTPV).Methods Seven patients with CTPV who underwent liver transplantation in Henan Provincial People’s Hospital from January 2012 to January 2020 were selected,including 6 patients treated by portal vein thrombectomy and portal vein to portal vein anastomosis and 1 patient treated by end to end anastomosis of left renal vein to portal vein.However,1 of the 6 patient portal vein thrombectomy and portal vein to portal vein anastomosis had insufficient blood flow after surgery,therefore,the patient were treated by end to side anastomosis of right renal vein to portalvein.Results All the 7 patients were discharged without any complications.However,1 patient had portal vein thrombosis 40 d after operation,and the patient was treated with thrombolysis and anticoagulation;however,CTPV was still found in the patients again.One patient had portal vein anastomotic stenosis 2 years after operation,and CTPV reoccurred 4 years after operation in the patient.All the 7 patients have good liver function and normal life up to now.Conclusions Patients complicated with CTPV had high risk in liver transplantation.Portal vein thrombectomy and portal vein toportal vein anastomosis,renal vein to portal vein anastomosis could achieve successful portal revascularization,and patients have underwent splenectomy need anticoagulation and portal vein monitor frequently.