肝脏移植中门静脉机化血栓的外科对策  

Surgical strategy in patients with portal vein organized thrombosis during liver transplantation

作　　者：吴凤东[1] 臧运金[1] 陈新国[1] 刘煜[1] 任秀昀[1] 沈中阳[1] 

机构地区：[1]中国人民武装警察部队总医院肝脏移植研究所,北京100039

出　　处：《中国现代普通外科进展》2008年第6期508-510,共3页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:探讨肝脏移植中门静脉机化血栓的术中处理方法。方法:回顾分析我院41例肝移植门静脉机化血栓患者,22例在取栓后门静脉端端吻合,10例血栓段门静脉切除,8例门静脉与曲张内脏血管吻合,1例门腔半转位。结果:1例死于多脏器功能衰竭;1例死于肝动脉出血;1例术后门静脉血流不足,二次肝脏移植时缝扎分流的侧支后顺利康复;2例患者术后出现吻合口狭窄,均采用经皮肝穿刺门静脉支架置入治愈,其余36例患者分别随访6～20个月,门静脉血流均保持通畅。结论:存在门静脉机化血栓的患者行肝脏移植,首选血栓段门静脉切除或取栓后门静脉重建,当不能进行时采用门静脉与曲张内脏静脉吻合可取得较好效果。Objective： To study the surgical strategy of portal vein organized thrombosis（ PVOT） during liver transplantation （LT）. Methods： The clinical data of 41 patients with PVOT performed LT from January 2005 to June 2006 （359 cases） in our institute was retrospectively analyzed. The reconstruction of portal vein,（PV） were removing thrombosis in 22 cases, thromboendovenctomy in 10 cases, PV to splanchnic varicose vein in 8 cases, cavoportal hemitransposition in 1 case. Results： 1 case died of multiple organ failure, 1 case died of hepatic artery bleeding. Retransplantation and portosystemic shunt vein ligation were performed in 1 case 14 days after LT because of its insufficient PV flow 2 cases were found anastomotic stenosis and they were cured by balloon angioplasty and stent placement via hepatic vein .Other patients were followed up 6 to 20 months, all of them had normal PV flow. Conclusion： Thromboendovenectomy or removing thrombosis is applicable to manage PVOT during LT.

关 键 词：肝脏移植 门静脉血栓 

分 类 号：R657.3[医药卫生—外科学]