门静脉血栓对终末期肝硬化病人行肝移植手术的影响  

The impact of portal vein thrombosis on liver transplantation for patients with end-stage liver cirrhosis

作　　者：王文静[1] 胡安斌[1] 陈庆[2] 冯贤松[2] 朱晓峰[1] 

机构地区：[1]中山大学附属第一医院器官移植中心,广州510080 [2]华中科技大学同济医学院附属协和医院肝胆外科

出　　处：《腹部外科》2016年第5期363-367,共5页Journal of Abdominal Surgery

摘　　要：目的 探讨合并门静脉血栓（portal vein thrombosis,PVT）的终末期肝硬化病人行肝移植手术的处理方法及其疗效.方法 回顾性分析2010年1月至2015年12月在中山大学附属第一医院器官移植中心接受肝移植手术的152例终末期肝硬化病人的临床资料.32例合并PVT的病人作为PVT组,其中Ⅰ级10例、Ⅱ级13例、Ⅲ级8例、Ⅳ级1例.其余120例无PVT的病人作为对照组.结果 PVT组术前脾切除史的比例明显高于对照组（46.8％比18.3％,P＜0.05）,差异有统计学意义.PVT组较对照组明显延长无肝期时间[（72.5±25.3）min比（57.6±18.4） min,P＜0.05]和总手术时间[（622.4±183.5） min比（503.2±123.6） min],差异均有统计学意义.2组病人在术中出血量、ICU住院时间、术后并发症发生率、围手术期病死率、1年及3年生存率的比较上差异均无统计学意义（P＞0.05）.PVT组术后再栓塞率高于对照组（9.4％比1.7％,P＜0.05）.结论 门静脉血栓一定程度上增加了终末期肝硬化病人肝移植手术的难度,Ⅰ～Ⅲ级PVT不影响病人的预后,仍可通过肝移植手术取得良好的疗效.Ⅳ级PVT肝移植手术的难度和风险会明显增加,应谨慎对待.Objective To investigate the treatment and curative effectiveness of liver transplan- tation in patients with end-stage liver cirrhosis complicated with portal vein thrombosis （PVT）. Meth- ods The clinical data of 152 patients with end-stage liver cirrhosis undergoing liver transplantation in the First Affiliated Hospital of Sun Yat-sen University from January 2010 to December 2015 were ret- rospectively analyzed. Thirty-two cases of PVT were classified as PVT group, including 10, 13, 8 and 1 of grade Ⅰ , Ⅱ, Ⅲ, and Ⅳ respectively. The remaining 120 cases without PVT were classified as control group. Results As compared with the control group, the proportion of preoperative splenecto- my in PVT group was significantly higher than that in control group （46. 8% vs. 18. 3%, P〈0. 05）. The anhepatic phase time （72. 5 ± 25.3 vs. 57.6 ± 18. 4 min, P〈0. 05） and the operation time （622. 4 ± 183. 5 vs. 503. 2 ± 123.6 rain） in PVT group were significantly longer than in control group respec- tively, but intraoperative blood loss, average ICU stay, the incidence of postoperative complications, perioperative mortality, and 1- and 3-year survival rate showed＇ no statistically significant differences between the two groups （P〉0. 05）. The recurrent rate of postoperative PVT was remarkably higher in PVT group than in control group （9. 4% vs. 1.7%, P〈0. 05）. Conclusions To a certain extent, PVT increased the difficulty of liver transplantation in patients with end-stage liver cirrhosis. Grade Ⅰ-Ⅲ PVT didn＇t affect the prognosis of patients. The difficulty and risk of liver transplantation in pa- tients with grade IV PVT were significantly increased and should be treated with caution.

关 键 词：肝移植 门静脉血栓 终末期肝硬化 

分 类 号：R657.3[医药卫生—外科学]