肝静脉分型对背驮式肝移植术后静脉流出道梗阻的临床意义  

A classification for hepatic venous outflow obstruction after piggyback liver transplantation and its clinical significance

作　　者：乔兵兵[1] 范林[2] 叶啟发[2] 

机构地区：[1]郑州大学第一附属医院肝胆胰外科,450052 [2]武汉大学中南医院肝胆疾病研究院武汉大学移植中心

出　　处：《中华肝胆外科杂志》2016年第7期437-440,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：湖北省自然科学基金（2015CFA018）

摘　　要：目的探讨肝静脉分型对背驮式肝移植术后肝静脉流出道梗阻（HV00）的临床意义。方法回顾性分析2000年5月至2007年8月于本中心按肝静脉分型施行原位肝移植术的248例患者临床资料，分析HV00发生的原因及处理对策。结果248例肝移植患者中，共发生术后静脉流出道梗阻38例。其中肝上下腔静脉吻合口狭窄2例（5．26％）、肝静脉吻合口扭转成角13例（34．21％）、肝后段下腔静脉狭窄7例（18．42％）、肝静脉流出道梗阻16例（42．10％）。经典背驮式组（n=216）发生34例术后静脉流出道梗阻，改良背驮式组（n=17）发生2例，经典原位肝移植组（n=15）发生2例。通过手术治疗和介入治疗后大部分患者肝静脉回流受阻得到改善。结论背驮式肝移植术后静脉流出道梗阻的发生与肝静脉吻合技术、手术方式选择以及供受者肝体积不匹配有关。按照肝静脉分型选择合适的术式，发现流出道梗阻后正确治疗可以减少该并发症的发生，改善患者预后。Objective A classification for hepatic venous outflow obstruction after piggyback liver transplantation （PBLT） and its clinical significance. Methods We conducted a retrospective study on 248 patients who underwent liver transplantation from May 2000 to August 2006. The aims were to elucidate the causes and treatment of postoperative venous outflow obstruction. Results Venous outflow obstruction oc- curred in 38 patients after transplantation. Among those, 2 （5.26%） had superior hepatic inferior vena ca- va （IVC） stenosis, 13 （34, 21% ） had the hepatic vein anastomosis twisted at an angle, 7 （18.42%） had IVC stenosis at the posthepatic segment, and 16 （42.10%） had outflow obstruction at the hepatic veins. In these 38 patients, 34 underwent PBLT, 2 underwent APBLT, and 2 COLT. Most patients with hepatic ve- nous outflow obstruction improved with surgical treatment and interventional therapy. Conclusions Hepatic vein outflow obstruction was associated with the technique of hepatic vein anastomosis, the type of cavocaval anastomosis and graft size mismatch between the donor and the recipient. Performing piggyback liver trans-plantation according to the classification of hepatic vein and appropriate treatments could improve the prognosis of venous outflow obstruction in clinical practice.

关 键 词：肝静脉 分型 流出道梗阻 肝移植 

分 类 号：R657.3[医药卫生—外科学]