血管内支架植入治疗部分肝移植术后流出道狭窄

Treatment with intravascular stent insertion for hepatic venous outflow obstruction after partial liver transplantation

目的 探讨血管内支架治疗肝移植术后流出道狭窄的适应症、手术时机、操作要领、后续治疗等。方法 总结我院2例左半肝移植术后流出道狭窄患者的诊断和治疗经过,通过股静脉进行肝静脉造影并测压,证实2例患者存在肝静脉-下腔静脉吻合口狭窄,经球囊血管扩张后置入血管内支架。结果 2例患者经血管支架治疗后,肝静脉内压力迅速回降,腹水等症状逐渐消失,肝功能恢复正常。观察6个月,无相关并发症发生,最终解决了肝静脉流出道狭窄的问题。结论 肝移植术后流出道狭窄严重影响患者近期和远期预后,早期诊断、早期干预是治疗肝移植术后流出道狭窄的关键。介入下血管内支架植入是肝移植术后流出道狭窄的有效治疗措施之一,可以一定程度改善患者预后。

Objective To explore the indications,treatment timing,operative technique and subsequent treatment of endovascular stent for hepatic venous outflow obstruction after split liver transplantation.Methods The diagnosis and treatment of two patients with hepatic venous outflow obstruction after left hemi-liver transplantation were summarized.Hepatic vein angiography and pressure measurement were performed through the femoral vein,which help us to confirm the diagnosis of hepatic vein-inferior vena cava anastomosis stenosis.Then,they were treated with endovascular stent after balloon vascular dilatation.Results Related symptoms such as hepatic venous hypertension and ascites have disappeared rapidly after endovascular stent treatment in both the two patients.During the next 6-month follow-up,the outflow obstruction of these two cases were cured with no associated complication.Conclusion Hepatic venous outflow obstruction after liver transplantation may seriously affects the patients′perioperative recovery and long-term prognosis,early diagnosis and treatment are the key to which.Endovascular stent implantation is one of the effective treatments for outflow obstruction after liver transplantation,which may improve the patient′s prognosis.