经皮穿肝介入治疗肝移植(LT)术后门静脉并发症(PVC)——附长期随访报告  

Percutaneous transhepatic interventional therapy for portal vein complications (PVC) after liver transplantation (LT): long-term follow-up results

作　　者：张华 王建华 刘嵘 钱晟 王飞[3] ZHANG Hua;WANG Jian-hua;LIU Rong;QIAN Sheng;WANG Fei(Department of Interventional Radiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Shanghai Institute of Medical Imaging,Shanghai 200032,China;Department of Interventional Radiology,Xinxiang Central Hospital,Xinxiang 453000,Henan Province,China)

机构地区：[1]复旦大学附属中山医院介入治疗科,上海200032 [2]上海市影像医学研究所,上海200032 [3]新乡市中心医院介入科,新乡453000

出　　处：《复旦学报（医学版）》2019年第6期764-768,共5页Fudan University Journal of Medical Sciences

摘　　要：目的评估经皮穿肝介入治疗肝移植(liver transplantation,LT)术后门静脉并发症(portal vein complications,PVC)的近期与远期疗效,总结相关处理经验。方法对复旦大学附属中山医院2003年1月至2015年12月收治的26例LT术后PVC患者的介入处理方式和长期随访资料进行回顾性分析。结果26例PVC中,门静脉主干狭窄21例,术前跨狭窄压力梯度为2~24 cmH2O[(9.8±7.3)cmH2O],术后压力梯度为0~3 cmH2O[(1.2±0.9)cmH2O]。26例PVC患者均采用经皮穿肝支架植入联合球囊扩张,其中5例门静脉血栓形成患者另联合采用经皮穿肝局部置管溶栓术。技术成功率及临床成功率100%(26/26),无介入操作相关并发症。门静脉1、3、5、10年通畅率分别为96%、92%、88%、84%。门静脉患者1、3、5、10年生存率分别为96%、84%、84%、40%,患者的中位生存期为110个月。结论经皮穿肝介入治疗LT术后PVC操作简便、疗效确切,可获得良好的近期及远期疗效,可作为LT术后PVC特别是门静脉狭窄患者的首选治疗方案。Objective To evaluate the short-term and long-term efficacy and to summarize the relevant management experience of percutaneous transhepatic interventional for portal vein complications(PVC)after liver transplantation(LT).Methods We retrospectively analyzed the interventional treatment and long-term follow-up data of 26 patients with PVC in Zhongshan Hospital,Fudan University from Jan.2003 to Dec.2015.Results Among 26 patients,twenty-one were observed portal vein stenosis.The pressure gradient across the stenosis before procedure was 2-24 cmH2O[(9.8±7.3)cmH2O].Postoperative pressure gradient was 0-3 cmH2O[(1.2±0.9)cmH2O].The 26 patients with PVC were performed with stent implantation and balloon dilatation in percutaneous transhepatic.Five patients with portal vein thrombosis were performed with urokinase thrombolytic therapy and stents implantation in percutaneous transhepatic.Technical and clinical success rates were 26/26.No complication associated with interventional procedures was observed.The patency rates of portal vein in 1,3,5,10 years were 96%,92%,88%and 84%,respectively.The rate of overall survival in 1,3,5,10 years were 96%,84%,84%and 40%,respectively.The median obstructive free time was 110 months.Conclusions The interventional percutaneous transhepatic approach for the treatment of PVC after LT is simple and effective.Good short-term and long-term results can be obtained.It can be used as the first treatment for PVC,especially for the patients with portal vein stenosis after LT.

关 键 词：肝移植(LT) 门静脉并发症(PVC) 介入治疗 经皮穿肝途径 

分 类 号：R657.3[医药卫生—外科学]