肝移植术后血管并发症的原因与对策

Etiology and Management of Vascular Complications After Liver Transplantation

【目的】探讨肝移植术后血管并发症的病因和对策。【方法】回顾性分析180例次原位肝移植临床资料。【结果】血管并发症发生率为11%;肝动脉并发症发生率为4%,与肝动脉并发症相关的病死率为3%(5/180);门静脉并发症发生率为3%,与门静脉并发症相关死亡率为0;肝后下腔静脉狭窄并发症发生率为3%。【结论】早期动脉并发症与手术技术和肝动脉病变关系密切,改进吻合技术,术前评估肝动脉病变和避免高凝能降低早期肝动脉并发症发生率;术前有门脉高压症手术治疗史、移植术前门静脉血栓、门静脉手术史以及严重感染病史等是门静脉并发症的高危因素;腔静脉整形的改良背驮式肝移植能避免下腔静脉狭窄的发生。

Objective] To investigate the reasons and management of vascular complications after liver transplantation. 180 liver transplantations were reviewed retrospectively. The total incidence of vascular complications was 11% . The incidence of hepatic artery complications was 4% . The mortality related to hepatic artery complications was 3 % (5/180). The incidence of portal vein complications was 3% . The mortality related to portal vein complications was 0. The incidence of inferior vena cava complications was 3% . [ Conclusion] Technical aspects and pathological changes are main reasons for early hepatic artery complications. The improvement of surgical technique and the evaluation of hepatic artery have lessened this problem. Hypercoagulability should be avoided. Previous surgical management for portal hypertension, preoperative portal vein thrombosis, surgical history of portal vein and severe infection are associated with risk factors for portal vein complications after orthotopic liver transplantation. The modified PB ( cavaplasty ) technique can avoid inferior vena cava complications.