再次肝移植血管并发症的防治

Vascular complications following second-orthotopic liver transplantation: prevention and treatment

目的 探讨再次原位肝移植后血管并发症的防治方法。方法 例 1病人因慢性排斥反应再次行原位肝移植术 ,术后发现肝动脉血栓形成 ,行血栓取出、溶栓、再血管化手术。例 2因胆管坏死再次行原位肝移植术 ,术后发现下腔静脉狭窄 ,行下腔静脉球囊扩张、内支架置入术。结果 例 1术后彩超未能探及肝动脉血流。例 2下腔静脉复通。结论 慢性排斥反应再次肝移植利用受体肝动脉进行吻合 ,可能增加肝动脉血栓形成机会。预防的关键是重新选择受体肝动脉吻合支 ,第 3次肝移植是优先选择方案。原下腔静脉吻合口关闭后若疑有狭窄可能 ,应于狭窄段近心端重新寻找吻合段。球囊扩张。

Objective To report the experience of prevention and treatment of vascular complications following second orthotopic liver transplantation.Methods HAT was found in a patient who got second OLT because of CR. The patient received removal and fusion procedures of intra arterial embolus .Results Color doppler couldn't find hepatic artery after operation. The patient died of hepatic failure after four days. Stenosis of inferior vena cava was found in a patient got second OLT because of bile duct putrescence.Conclusion The chance of HAT will increase if hepatic artery of receptor become a anastomose branch again in a patient with CR. The key method of prevention is reselection of anastomose branch .Interventional procedure is unsuitable for these patients. The curative effect of revascularization is uncertainty .The third OLT may be the best choice. If it is possible to lead stenosis after closing former inferior vena cava anastomose scoop, you must look for anastomose sect on close heart end. Balloon dilation and stent replacement is effective methods for stenosis of inferior vena cava.