肝移植术后缺血型胆道病变并发门静脉高压症患者临床分析  

Clinical analysis of patients with ischemic type biliary lesions and portal hypertension after liver transplantation

作　　者：易慧敏[1] 张在东[1] 张彤[1] 傅斌生[1] 陈云浩[1] 任杰[1] 孟炜[1] 杨扬[1] 易述红[1] 陈规划[1] 

机构地区：[1]中山大学附属第三医院肝移植中心,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2014年第6期16-19,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省科技计划项目(2011B031800060);广东省自然科学基金(S2012010009333);广州市科技计划重大民生专项基金(2011Y1-00033-2)

摘　　要：目的探讨肝移植术后缺血型胆道病变(ITBL)并发门静脉高压症的发生、发展及其治疗、预后。方法回顾性分析2003年1月至2009年4月在中山大学附属第三医院肝移植中心行肝移植术且术后确诊为ITBL并发门静脉高压症的32例患者临床资料。所有患者均签署知情同意书,符合医学伦理学规定。其中男28例,女4例;平均年龄(46±14)岁。对患者进行定期随访,观察患者门静脉高压症发生、发展及其治疗和预后情况。结果 ITBL确诊时患者合并轻度脾肿大11例,中度脾肿大14例,重度脾肿大4例,无脾肿大3例。随访期间5例病情稳定,脾肿大保持在轻度或由中度转为轻度;余27例脾肿大等门静脉高压症状随着ITBL病变进展而加重,其中发展至重度脾肿大者11例。53%(17/32)患者出现食管胃底静脉曲张,其中食管下段轻度静脉曲张2例,食管下段胃底轻-中度静脉曲张8例、中-重度静脉曲张7例。所有患者均接受经内镜下逆行性胰胆管造影术(ERCP)或经皮经肝胆道造影术(PTC)途径介入治疗,行再次肝移植术11例、胆肠吻合术4例、胆总管切开取石+胆道探查术1例。患者存活18例,死亡14例,其中死于黄疸加深肝功能恶化4例、肝癌复发4例、上消化道大出血3例,再次肝移植术后重度感染1例、多器官功能衰竭1例、肾衰竭1例。结论大部分肝移植术后ITBL并发门静脉高压症患者随着ITBL进展而病情逐渐加重。治疗方式主要包括介入治疗、再次肝移植、胆肠吻合,患者预后极差。Objective To investigate the occurrence, development, treatments and prognosis of ischemic type biliary lesions （ITBL） complicated with portal hypertension after liver transplantation （LT）. MethodsClinical data of 32 ITBL patients with portal hypertension after LT in Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University from January 2003 to April 2009 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. There were 28 males and 4 females with a mean age of （46±14） years old. The patients were followed up regularly and the occurrence, development, treatments and prognosis of portal hypertension were observed.ResultsWhen ITBL was diagnosed, mild splenomegaly was found in 11 cases, moderate splenomegaly in 14 cases and severe splenomegaly in 4 cases. Three cases were observed without splenomegaly. During the follow-up period, 5 cases were observed in stable states with mild splenomegaly or splenomegaly improving from moderate to mild. While for the other 27 cases, portal hypertension symptoms like splenomegalyetc. were observed becoming worse as ITBL developed including 11 cases with severe splenomegaly. Esophageal and gastric fundus varices were found in 53% （17/32） of the patients including 2 cases of lower esophagus mild varices, 8 cases of lower esophagus and gastric fundus mild to moderate varices, and 7 cases of moderate to severe varices. All the patients received intervention treatments via endoscopic retrograde cholangiopancreatography （ERCP） or percutaneous transhepatic cholangiography （PTC）. Liver retransplantation was performed in 11 cases, choledochojejunostomy in 4 cases and choledocholithiasis ＋ biliary tract exploration in 1 case. Eighteen cases survived and 14 cases died. Four cases died of aggravating jaundice and liver failure, 4 liver cancer recurrence, 3 massive hemorrhage in upper gastrointestinal tract, and 1 severe infection, 1 multiple organ failure, 1 rena

关 键 词：肝移植 胆道疾病 高血压 门静脉 食管和胃静脉曲张 脾大 

分 类 号：R657.3[医药卫生—外科学]