原位肝移植术后肝动脉血栓形成的诊断和治疗  

Hepatic artery thrombosis following orthotopic liver transplantation:angiographic diagnosis and treatment.

作　　者：王国栋[1] 陈规划[1] 何晓顺[1] 朱晓峰[1] 陆敏强[1] 杨杨 黄洁夫[1] 

机构地区：[1]中山医科大学附属第一医院移植外科,广州510080

出　　处：《中国实用外科杂志》2000年第8期473-475,共3页Chinese Journal of Practical Surgery

摘　　要：目的　探讨原位肝移植术后肝动脉血栓形成的诊治经验。方法　总结 34例原位肝移植术后的临床资料 ,结合文献 ,分析肝移植术后肝动脉血栓形成的诊断和不同治疗方法的结果。结果　本组肝动脉血栓形成发生率为 8 8% (3/34 ) ,3例均经彩超检查诊断 ,例 1术后第 5 7天死于上消化道出血 ,经尸检证实。例 2和例 3经肝动脉造影证实后给予动脉内溶栓 ,球囊扩张成形及放置血管内支架等介入治疗 ,病人分别在术后第 1 8、6 5天死于感染和肝功能衰竭。 3例病人术后早期均出现急性排斥反应。结论　介入治疗宜作为过渡性的治疗方法 。Objective To report the experience of diagnosis and treatment of hepatic artery thrombosis(HAT) following orthotopic liver transplantation.Methods The clinical data of 34 orthotopic liver transplantation patients were reviewed.Diagnosis and results with different treatment methods were analyzed.Results The incidence of HAT in our group was 8 8% (3/34).All of 3 cases of HAT were correctly identified by colour duplex ultrasonography.The first case , confirmed by autopsy, died of upper digestive tract bleeding on postoperative day 57 Other two cases were confirmed by hepatic artery angiography and then received interventional procedures with high dose of intraarterial urokinase;hepatic artery balloon angioplasty and intraarterial metallic stent was also performed.The patients died of sepsis and hepatic failure on postoperative day 18 and 65, respectively.All three recipients developed early acute rejections from the biopsy specimen before HAT was diagnosed.Conclusion Interventional procedure is suitable for transient management of HAT and urgent revascularisation may obtain better results.

关 键 词：原位肝移植 肝动脉血栓形成 介入治疗 再血管化 

分 类 号：R657.306[医药卫生—外科学]