摘要
目的 探讨肝移植术后动脉并发症的早期诊断与治疗方法。方法 回顾性分析本院 180例次原位肝移植术后动脉并发症的监测、诊断与处理。结果 动脉并发症发生率为 5 .0 % (9/ 180 ) ,其中肝动脉血栓形成 (HAT ) 5例 ,肝动脉狭窄 (HAS) 3例 ,腹腔动脉狭窄 1例。 8例动脉造影证实 ,1例尸检证实。彩色多普勒超声 (CDI)的诊断敏感度和特异度分别为 88.9%和 95 .9% ;术中超声(IOUS)的敏感度、特异度、阳性预测值和阴性预测值分别为 10 0 % ,96.0 % ,66.7%和 10 0 %。 3例患者接受介入治疗、3例接受再血管化手术、2例分别接受再次肝移植和非手术治疗。 3例治愈 ,6例死亡。结论 CDI是监测动脉并发症的首选方法 ;IOUS有助于术中的早期诊断。HAS和HAT治疗应首选再血管化或再次肝移植 ;介入溶栓的疗效不佳 ;个别患者可尝试非手术治疗。
Objective To explore the diagnosis and management of arterial complications after orthotopic liver transplantation (OLT). Methods The incidence, diagnosis and management of arterial complications of 180 OLT patients were analyzed retrospectively. Results A 5.0%(9/180)arterial complication rate was identified by selective angiography (8/9) and autopsy (1/9) in the 180 recipients, including 5 cases of hepatic artery thrombosis (HAT),3 cases of hepatic artery stenosis (HAS)and 1 celiac artery stenosis. Diagnostic sensitivity and specificity for arterial complications by color Doppler image (CDI) were 88.9% and 95.9% .The diagnostic sensitivity, specificity, positive and negative predictive value of intraoperative ultrasonography (IOUS) for arterial complications were 100%, 96.0%, 66.7% and 100%, respectively . Interventional procedures, revascularization, retransplantation and conservative treatment were used for 3,3,2 and 1 recipient respectively. Three patients were cured and 6 patients died. Conclusions CDI is a sensitive and specific way of monitoring arterial complications after OLT, and IOUS contributes to the early diagnosis. Revascularization and retransplantation are principal management for the patients with HAS or HAT. The conservative treatment might be effective for some asymptomatic patients, but interventional procedures may not obtain good results.
出处
《中国普通外科杂志》
CAS
CSCD
2003年第3期183-186,共4页
China Journal of General Surgery
基金
卫生部临床学科重点资助项目 (2 0 0 1 32 1 )
广东省科委攻关基金资助项目 (99B0 670 5G)
广州市科委基金资助项目 (2 0 0 1 -Z - 0 4 3- 0 1 - 1 )
广东省卫生厅基金资助项目 (2 0 0 2 1 64)