冠状动脉支架放置术治疗肝移植术后肝动脉狭窄  

Stent placement in treating hepatic artery stenosis after liver transplantation

作　　者：黄明声[1] 姜在波[1] 李征然[1] 关守海[1] 朱康顺[1] 陈规划[2] 陆敏强[2] 单鸿[1] 

机构地区：[1]中山大学附属第三医院放射科,广州510630 [2]中山大学附属第三医院移植中心,广州510630

出　　处：《中华肝脏病杂志》2006年第8期582-586,共5页Chinese Journal of Hepatology

基　　金：广东省自然科学基金研究团队项目(05200177)

摘　　要：目的评价肝移植术后肝动脉狭窄时冠状动脉支架应用的可行性和有效性。方法2003年11月至2005年9月,14例肝移植术后肝动脉狭窄患者接受肝动脉冠状动脉支架放置术治疗,其中早期治疗10例,延迟治疗4例。总结肝动脉冠状动脉支架放置术的技术结果、肝动脉通畅及患者临床转归等情况。结果冠状动脉支架放置术成功率达100％。中位随诊146d(9～345 d),2例患者分别于术后26 d和45 d出现再狭窄,其余患者肝动脉均保持通畅；10例早期介入治疗的患者中,2例分别于术后9 d和30 d死于败血症性多器官功能衰竭,1例患者由于反复胆道感染于术后147 d接受再次肝移植,其余患者术后肝功能指标正常且无症状生存。4例延迟治疗的患者中,1例生存至今已345 d,但肝功能反复出现异常,其余3例死于肝脓肿和胆道感染导致的多器官功能衰竭。结论肝动脉冠状动脉支架放置术可以成功治疗肝移植术后肝动脉狭窄,早期介入治疗是取得良好的临床疗效的关键。Objective To evaluate the feasibility and effectiveness of stent placement in treating hepatic artery stenosis after orthotopic liver transplantation (OLT). Methods From November 2003 to September 2005, 14 patients who had hepatic artery stenosis after OLT underwent stent placement in their narrowed hepatic arteries. This included early interventional treatment in 10 patients and delayed interventional treatment in 4 patients. The technical results, clinical outcomes, and the hepaticartery patencies were reviewed. Results Technical and immediate success was 100%. After a mean follow-up of 146 days(range, 9-345 days), all patients's hepatic arteries were patent, except that hepatic arterious restenoses occurred in 2 patients at 26 and 45 days after the stent placement. Of the 10 patients who received early treatment, 8 survived with normal results of liver function test and 2 patients died of septic multiple-organ failure at 9 and 30 days after the stent procedure. One patient received a retransplantation because of refractory biliary infection. Of the 4 patients who received a delayed interventional treatment, 1 patient survived for 345 days but with abnormal liver functional test results, the other 3 patients died of septic multiple-organ failure resulting from liver abscesses biliary infection. Conclusion Hepatic artery stenosis after OLT can successfully be treated with stent placement and an early interventional treatment is the key for a good clinical outcome.

关 键 词：肝移植 放射学 介入性 肝动脉狭窄 

分 类 号：R657.3[医药卫生—外科学]