肝移植术后门静脉系统血栓形成的诊治  

The analysis of portal vein thrombosis following orthotopic liver transplantation

作　　者：游燊[1] 何晓顺[1] 胡安斌[1] 熊俊[1] 巫林伟[1] 王东平[1] 王国栋[1] 马毅[1] 鞠卫强[1] 黄洁夫[2] 

机构地区：[1]中山大学附属第一医院器官移植科,广州510080 [2]中国医学科学院中国协和医科大学北京协和医院肝脏外科

出　　处：《中华外科杂志》2008年第3期176-178,共3页Chinese Journal of Surgery

基　　金：教育部新世纪优秀人才支持计划资助项目（NCET-04-0794）

摘　　要：目的总结肝移植术后门静脉系统血栓形成的临床特点及诊疗体会。方法回顾2003年1月至2007年2月期间402例接受肝移植患者的临床资料，对其中9例肝移植术后门静脉系统血栓形成的原因、预后及诊治方案进行回顾性分析。结果9例患者均接受全身抗凝、祛聚治疗，其中1例行经皮腔内血管成形术并血管内支架置入术、1例行经皮门静脉置管溶栓并再次肝移植、1例行外科手术取栓治疗。有6例患者分别于术后9、30、34、40、48、62d死于多器官功能衰竭，3例长期存活。结论门静脉病变、血流状态改变、高凝状态及手术操作不当是造成术后门静脉血栓形成的主要原因，对高危患者进行预防性治疗，对已形成的病变早期诊断，积极的综合性干预是提高预后的关键。Objective To investigate and summarize the experience in clinical presentation, diagnosis and treatment of portal vein thrombosis after orthotopic liver transplantation（OLT）. Methods The clinical data of 402 patients who underwent OLT from January 2003 to February 2007 were reviewed. A retrospective study was performed on etiology, prognosis and treatment in 9 cases of portal vein thrombosis after OLT. Results All of the 9 cases received anticoagulant and antiaggregation therapy, within whom one underwent pereutaneous transluminal angioplasty and stent placement, one underwent retransplantation after failure of thrombolysis therapy, and one received surgical embolectomy. Six patients died of multiple organ failure on 9^th, 30^th, 34^th, 40^th, 48^th, 62^th days, respectively, while 3 patients survived. Conclusions The major risk factors of portal vein thrombosis after OLT were pathological changes in portal vein, abnormal blood stream dynamics, hypercoagulable status and improper surgical technique. Prophylactic intervention to patients with high risk factors ,early diagnosis and aggressive comprehensive therapy on portal vein thrombosis patients are essential to improve prognosis.

关 键 词：肝移植 静脉血栓形成 治疗 

分 类 号：R686[医药卫生—骨科学]