弥漫性门静脉血栓形成肝移植受者门静脉重建方式及效果  

Strategies and outcomes of portal vein reconstruction of liver transplantation recipient with diffuse portal vein thrombosis

作　　者：史远斌 温培豪[1] 张嘉凯[1] 郭文治[1] 张水军[1] Shi Yuanbin;Wen Peihao;Zhang Jiakai;Guo Wenzhi;Zhang Shuijun(Department of Hepatobiliary&Pancreatic Surgery,First Affiliated Hospital,Zhengzhou University,National Regional Medical Treatment Center of Henan Organ Transplantation,Henan Organ Transplantation Center,Henan Organ Transplantation Quality Control Center,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院肝胆胰外科,河南省器官移植国家区域医疗中心,河南省器官移植中心,河南省器官移植质控中心,郑州450052

出　　处：《中华器官移植杂志》2022年第5期287-291,共5页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金面上项目 (82170648,82170670)。

摘　　要：目的探讨弥漫性门静脉血栓形成(portal vein thrombosis,PVT)肝移植受者门静脉重建方式及效果。方法回顾性分析2014年1月至2019年6月郑州大学第一附属医院完成的10例弥漫性PVT肝移植受者的临床资料。其中,男8例,女2例;年龄(50.7±10.1)岁,范围在25~63岁;术后随访时间(66.3±25.8)个月,范围在8~96个月。彩色超声检查评估门静脉吻合口直径、门静脉内径和流速及有无腹水等,CT检查评估有无食管胃底静脉曲张。依此评估门静脉血流通畅情况、门静脉高压症治疗效果和受者生存状况。结果无粗大门静脉侧支循环7例中,行门腔静脉半转位吻合术6例,门静脉左肾静脉吻合术1例。术后6个月内受者腹水等门静脉高压症状逐渐缓解,其中4例仍有少量腹水,但上消化道出血术后未复发。截至2021年12月,受者门静脉血流通畅4例,死亡3例。其中,术后3个月出现下腔静脉血栓形成和肾损伤,术后8个月死于多器官衰竭1例;术后11个月死于原发病(肝癌)复发1例;术后44个月死于脑卒中1例。合并粗大门静脉侧支循环3例,根据侧支循环不同,行门静脉胃右静脉吻合术1例,行门静脉胃冠状静脉吻合术1例,行门静脉胆道周围曲张静脉吻合术1例。术后2个月内,3例生理性门静脉重建受者腹水等门静脉高压症状均逐渐缓解。其中,行门静脉胃冠状静脉吻合受者术后1个月吻合口血栓形成,抗凝溶栓治疗后吻合口恢复通畅。术后36个月出现上消化道出血,予以内镜下套扎和硬化治疗后症状缓解。另2例受者门静脉血流通畅。在最后一次随访中,存活的7例受者门静脉流速均在20 cm/s以上,肝功能正常。结论弥漫性PVT肝移植受者选择合适的门静脉重建方式,可以保证足够的移植肝门静脉血流。术后受者门静脉高压可消退,肝功能可恢复正常。Objective To summarize the strategies and effects of portal vein reconstruction after liver transplantation in recipients with diffuse portal vein thrombosis(PVT).Methods Clinical data were retrospectively reviewed for 10 PVT patients undergoing liver transplantation(LT)from January 2014 to June 2019.There were 8 males and 2 females with a age of(50.7±10.1)years.The follow-up period was(66.3±25.8)months.Diameter of portal vein anastomosis,diameter and flow velocity of portal vein and presence of ascites were evaluated by color Doppler ultrasound.And computed tomography(CT)was employed for assessing the presence of esophagogastric varices.And patency of portal vein blood flow,therapeutic outcomes of portal hypertension and survival status of recipients were evaluated.Results Among 7 patients with diffuse PVT without enlarged collaterals,cavoportal hemitransposition(n=6)and renoportal anastomosis(n=1)were performed.Ascites subsided gradually and minimal ascites(n=4)perdisted.Variceal bleeding did not recur within 6 months.As of December 2021,portal vein blood flow remained unobstructed in 4 recipients and 3 patients died.One case of inferior vena cava thrombosis and renal injury at 3 months post operation died of multiple organ failuer at 8 months post-operation.Another patient died of recurrent hepatocarcinoma at 11 months post-operation.Another case died of stroke at 44 months post-operation.Among 3 patients with diffuse PVT complicated with enlarged collaterals,there were right gastric vein to portal vein anastomosis(n=1),gastric coronary vein to portal vein anastomosis(n=1)and pericholedochalvarix to portal anastomosis(n=1).Ascites gradually subsided within 2 months post-operation.Portal vein anastomosis thrombosis was formed 1 month after operation and racanalizated after anticogulation and thrombosis therapies in patient with gastric coronary vein to portal vein anastomosis.Upper gastroinstestinal hemorrhage occurred 36 months after operation and was relieved by endoscopic ligation and sclerotherapy.Blood f

关 键 词：肝移植 门静脉血栓形成 重建 治疗结果 

分 类 号：R657.3[医药卫生—外科学]