肝移植术后早期发生肝动脉血栓形成的诊疗及预后分析  

Analysis of diagnosis treatment and prognosis of early hepatic artery thrombosis after liver transplantation

作　　者：王振顺 刘召波 孙力波[2] 武聚山[2] 林栋栋[1] Wang Zhenshun;Liu Zhaobo;Sun Libo;Wu Jushan;Lin Dongdong(Department of General Surgery,Xuanwu Hospital,Captital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院普通外科,北京100053 [2]首都医科大学附属北京佑安医院普通外科中心

出　　处：《北京医学》2022年第10期888-891,896,共5页Beijing Medical Journal

摘　　要：目的探讨肝移植术后早期发生肝动脉血栓形成(hepatic artery thrombosis,HAT)的诊疗经验及预后情况。方法选取2020年1月至2021年7月首都医科大学附属北京佑安医院完成肝移植手术的患者271例,回顾性分析肝移植术后早期发生HAT患者的术前基本情况、术后HAT诊疗和预后情况。结果271例肝移植患者中,4例于术后早期发生HAT,发生率为1.5%,其中1例为术后第2天发生HAT,急诊以异体髂动脉行肝动脉重建术;3例分别于术后第6、7、10天发生HAT,均行介入溶栓治疗,有2例溶栓后再通,溶栓后序贯抗凝治疗,1例溶栓后未再通,并于术后3个月形成门静脉血栓,术后5个月因胆道并发症放置胆管支架。4例患者目前均存活。结论术后早期常规监测患者肝功能及肝脏血流变化,有助于早期发现HAT,及时行介入溶栓或肝动脉重建等治疗能够改善患者预后。Objective To explore the experience of diagnosis,treatment and prognosis of early hepatic artery thrombosis(HAT)after liver transplantation.Methods A total of 271 patients underwent liver transplantation in Beijing Youan Hospital,Capital Medical University from January 2020 to July 2021 were selected.The preoperative basic information,postoperative HAT diagnosis,treatment and prognosis of HAT patients were retrospectively analyzed.Results Among the 271 patients,four patients developed HAT in the early stage after operation,the incidence rate was 1.5%.Among them,one case developed HAT on the second day after the operation,and underwent emergency hepatic artery reconstruction with allogeneic iliac artery in emergency.The other three cases developed HAT on the 6th,7th and 10th day after the surgery,and all of them were treated with interventional thrombolysis.Among the three cases,two cases were recanalized after thrombolysis,followed by sequential anticoagulation.One case was not recanalized after thrombolysis,and portal vein thrombosis was formed three months after surgery,and biliary stents were placed due to the biliary complications five months after the surgery.All the four patients were alive at present.Conclusions Routine monitoring of liver function and liver blood flow changes in patients in the early postoperative period is helpful for early detection of HAT.Timely interventional thrombolysis or hepatic artery reconstruction can improve the prognosis of patients.

关 键 词：肝动脉血栓形成 肝移植 介入溶栓 预后 

分 类 号：R657.3[医药卫生—外科学]