肝移植术后血管并发症的病因学分析

Analysis of vascular complications after liver transplantation

目的 探讨肝移植术后血管并发症的病因。方法 对 1993年 4月～ 2 0 0 2年 4月所完成的 16 0例原位肝移植临床资料进行回顾性分析。结果 肝动脉并发症发生率为 5 % ,与肝动脉并发症相关的死亡率为3.13% ;门静脉并发症发生率为 3.75 % ,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3.75 %。结论 肝移植术后早期动脉并发症主要与手术技术和肝动脉病变有关 ,改进吻合技术 ,术前评估肝动脉病变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 ;手术技术是导致下腔静脉狭窄的重要原因 ,腔静脉整形的改良背驮式肝移植能避免该并发症的发生。

Objective:To investigate the reasons of vascular complications after liver transplantation. Methods:160 liver transplantations performed from Apr 1993 to Apr 2002 were reviewed retrospectively.Results:The incidence of hepatic artery complications was 5%, the mortality related to hepatic artery complications was 3.13%; The incidence of portal vein complications was 3.75%; the mortality related to portal vein complications was 0. The incidence of inferior vena cava complications was 3.75%. 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. Previous treatment for portal hypertension, portal vein thrombosis preoperational and severe infection was associated with risk factors for portal vein complications after orthotopic liver transplantation. Technical causes are important particularly for inferior vena cava complications. The modifying PB (cavaplasty) technique can avoid these.