肝移植受者术后发生门静脉血栓的危险因素分析及治疗方式探讨

Risk factors and treatment of portal vein thrombosis after liver transplantation

目的:探讨肝移植术后患者发生门静脉血栓(PVT)的危险因素及治疗方式。方法:回顾性分析2015年7月至2019年4月在解放军总医院第五医学中心行肝脏移植手术的290例受者的临床资料,其中男性245例,女性45例,中位年龄51(44,56)岁。依据肝移植受者术后是否发生PVT分为两组:PVT组(n=16)和非PVT组(n=274)。对比两组肝移植受者性别、年龄等临床资料。采用门诊和住院方式进行随访。分析肝移植受者术后发生PVT的危险因素。结果:290例肝移植受者术后随访时间59(42,73)个月,明确术后存在PVT者16例,发生率为5.5%(16/290)。多因素logistic回归分析显示,受者术前存在PVT(OR=12.773,95%CI:3.887~41.973)是肝移植术后发生PVT的独立危险因素。对于术后出现PVT的16例患者,其中10例行门静脉介入干预治疗,剩余6例患者由于症状轻微,口服阿司匹林或者利伐沙班抗凝治疗。PVT组受者术后3年生存率为93.8%(15/16),非PVT组受者术后3年生存率为90.1%(247/274),两组受者术后3年生存率间差异无统计学意义(χ^(2)<0.01,P=0.969)。结论:受者术前存在PVT是肝移植术后发生PVT的独立危险因素,对于术后出现PVT患者,选择合适的治疗方案,可获得较好疗效,且不影响长期预后。

Objective To study the risk factors and treatment of portal vein thrombosis(PVT)in patients after liver transplantation.Methods The clinical data of 290 recipients who underwent liver transplantation at the Department of Hepatology,the Fifth Medical Center of PLA General Hospital from July 2015 to April 2019 were retrospectively analyzed.There were 245 males and 45 females,with a median age of 51(44,56)years old.The liver transplantation recipients were divided into two groups according to whether PVT occurred or not after operation:the PVT group(n=16)and the non-PVT group(n=274).Gender,age and other clinical data of the recipients were compared between the two groups.Outpatient and inpatient follow-up were performed.The risk factors of postoperative PVT were analysed in the liver transplantation recipients.Results The median follow-up of these 290 liver transplant recipients was 59(42,73)months,and 16 patients were confirmed to have PVT after operation,with an incidence of 5.5%(16/290).Multivariate logistic regression analysis showed that preoperative PVT(OR=12.773,95%CI:3.887-41.973)was an independent risk factor for PVT after liver transplantation.For the 16 patients with postoperative PVT,10 were treated with portal vein intervention,and the remaining 6 patients were treated with oral aspirin or rivaroxaban anticoagulation due to mild symptoms.The 3-year survival rate of the PVT group was 93.8%(15/16),while that of the non-PVT group was 90.1%(247/274).There was no significant difference in the 3-year survival rates between the two groups(χ^(2)<0.01,P=0.969).Conclusions Preoperative PVT in recipients was an independent risk factor for PVT after liver transplantation.For patients with postoperative PVT,appropriate treatment resulted in good results without affecting the long-term prognosis of these patients.