儿童肝移植术后早期肝动脉血栓形成的诊断与治疗  

Diagnosis and treatment of early-stage hepatic artery thrombosis after pediatric liver transplantation

作　　者：曾志贵[1] 朱志军[2] 孙丽莹[2] 魏林[2] 曲伟[2] 刘颖[2] 何恩辉[3] 张梁[4] 汪栋[2] 刘洋[2] 王国军[2] 

机构地区：[1]天津医科大学,300384 [2]首都医科大学附属北京友谊医院普通外科国家消化系统疾病临床医学研究中心移植耐受与器官保护北京市重点实验室 [3]首都医科大学附属北京友谊医院超声科 [4]首都医科大学附属北京友谊医院麻醉科

出　　处：《中华器官移植杂志》2015年第4期197-200,共4页Chinese Journal of Organ Transplantation

基　　金：北京市医院管理局临床医学发展专项经费资助（XM201302）

摘　　要：目的探讨儿童肝移植术后早期肝动脉血栓形成（HAT）的诊断与治疗。方法回顾性分析2013年6月至2015年2月122例儿童肝移植的临床资料，分别观察儿童心脏死亡器官捐献（DcD）供肝移植和活体供肝移植术后早期发生HAT的诊断、治疗及转归情况。术后早期采用彩色多普勒超声监测肝动脉血流，怀疑HAT时行超声造影或腹部CT检查，确诊者予介入治疗、手术治疗或保守治疗。结果122例儿童肝移植中，73例为活体肝移植组，49例为DCD肝移植。活体肝移植组受者中，1例术后第7天并发HAT，发生率为1．3％，该例受者最终死于心功能衰竭，死亡时肝功能基本正常。儿童DCD肝移植受者中，9例于术后3～7d发生HAT，发生率为18．4％，其中2例随后并发门静脉血栓形成，最终因肝功能衰竭而死亡；其余7例存活，随访1～18个月，其中1例出现缺血性胆道病，2例并发肝脓肿，反复发热；其余4例肝功能正常，无胆道并发症。两组间HAT发生率的比较，差异有统计学意义（P=0．001）。结论儿童DCD供肝移植受者术后HAT的发生率明显高于活体肝移植受者，发生HAT后相关并发症和死亡率均较高。Objective To explore the diagnosis and treatment of early-stage hepatic artery thrombosis （HAT） after pediatric liver transplantation. Method A retrospective analysis was made to the diagnosis and treatment of early-stage HAT on 122 cases of consecutive pediatric liver transplantations between June 2013 and February 2015 in Beijing Friendship Hospital, including using the graft from donors Donation after Cardiac Death （DCD） and living-related donor liver transplantation. Hepatic arterial blood flow was monitored by color Doppler ultrasound screening （DUS） daily during the early time after transplantation. Contrast-enhanced ultrasound or abdominal CT examination was performed on recipients with suspected HAT. The patients with HAT were treated with interventional therapy, operation or conservative treatment. Result There were 73 cases from living-related liver donor and 49 cases from pediatric DCD in this group. HAT occurred in I case （1.3%） in living donor liver transplantation 7 days after operation. In DCD donor graft, HAT occurred in 9 cases （18. 4%） on the postoperative day 3-7, and 2 cases of them were subsequently complicated with portal vein thrombosis, and died due to hepatic failure. Conclusion The incidence of HAT was significantly higher in graft from DCD donor than the graft from living donor. The incidence of complications and mortality rate after HAT were also high.

关 键 词：儿童 肝移植 肝动脉血栓 彩色多普勒超声 

分 类 号：R657.3[医药卫生—外科学]