肝移植术后下腔静脉和肝静脉并发症的诊治:附16例次报告  

Diagnosis and Treatment of the Complications of Inferior Vena Cava and Hepatic Vein after Liver Transplantation:a Report of 16 Times of Operations

作　　者：贺轶锋[1] 周俭[1] 邱双健[1] 黄晓武[1] 孙健[1] 王晓颖[1] 史颖弘[1] 肖永胜[1] 王征[1] 孙绮蛮[1] 樊嘉[1] 

机构地区：[1]复旦大学附属中山医院肝外科,上海200032

出　　处：《中国临床医学》2014年第2期212-215,共4页Chinese Journal of Clinical Medicine

摘　　要：目的:研究肝移植术后下腔静脉和肝静脉并发症的特点以及如何早期诊治以减少移植物功能失缺。方法:回顾分析2001年4月—2013年9月复旦大学附属中山医院收治1185例肝移植患者(共1210例次肝移植术)的临床资料,分析移植术后下腔静脉和肝静脉并发症的发生率和治疗后患者的预后情况。结果:共发生16例次肝移植术后流出道并发症,发生率为1.3%,其中下腔静脉狭窄7例次,下腔静脉合并肝静脉狭窄6例次,肝静脉流出道梗阻3例次。7例次下腔静脉狭窄中有6例次通过经皮腔内血管成形术(球囊扩张与支架留置)治疗后完全治愈,随访至今除1例次因肝癌复发病死,其余患者未出现移植物功能失缺。6例次下腔静脉合并肝静脉狭窄患者中有5例次留置支架,其中1例次因生长发育造成下腔静脉内支架脱落及肝左静脉内腔再次狭窄,导致肝功能衰竭、上消化道出血而病死;其余4例次恢复良好。3例次肝静脉流出道梗阻患者中有2例次经肝右静脉内留置支架后恢复正常。结论:患者在肝移植术后如出现布加氏综合征的临床表现,需行彩色多普勒B超、增强CT及CT血管成像、介入下血管造影,以判断有无流出道并发症。在介入下置入金属支架是目前治疗肝移植术后流出道并发症的有效方法。Objective：To study the characteristics of the complications of inferior vena cava（IVC） and/or hepatic vein（HV）after liver transplantation and how to diagnose and treat the complications to reduce the graft loss in the early period. Methods： The clinical datum of 1185 patients （1210 liver transplants） from Apr 2001 to Sep 2013 in Zhongshan Hospital,Fudan University were retrospectively analyzed, and the incidence rate of the complications of inferior rena cava and hepatic vein and prognosis after treatment were investigated. Results： The outflow tract complications occurred in 16 （1.3 % ）of 1210 liver transplants. IVC stenosis was observed in 7 transplants, whereas concurrent IVC and HV stenosis was observed in 6 transplants and HV outflow obstruction was observed in 3 transplants. Six patients with IVC stenosis were treated with percutaneous transluminal angioplasty（PTA） with balloon dilation and stent placement. Except one patient dying of tumor recurrence, the others recovered well without graft loss until now. Five patients with concurrent IVC and HV stenosis were also treated by balloon dilation and stent placement. During the follow-up period,one patient died from liver failure and upper gastrointestinal hemorrhage for the stent displacement in IVC and the re-stenosis in the lumen of left HV when he grew up, while the other 4 patients survived well. In 2 patients with HV outflow obstruction, stents were placed in the right HV and patients recovered soon. Conclusions： Differential diagnosis of the complications of IVC and HV should be made by Doppler ultrasound,dynamic contrast-enhanced computed tomography（CT）, CT angiography and catheter angiography if patient presents with the symptoms of Budd-Chiari syndroms af ter liver transplantation. Percutaneous endovascular treatment with metallic stent placement is an effective and safe option for the treatment of such complications.

关 键 词：肝移植 下腔静脉 肝静脉 并发症 诊断与治疗 

分 类 号：R617[医药卫生—外科学]