肝移植术后门静脉瘤2例并文献复习  

Portal vein aneurysm after liver transplantation:report of two cases and literature review

作　　者：赵洪强 董草儿 侯昱丞 吴广东 童翾 李昂[1,2] 于里涵 卢倩 徐光勋 陈虹[1,2] 汤睿[1,2] Zhao Hongqiang;Dong Cao’er;Hou Yucheng;Wu Guangdong;Tong Xuan;Li Ang;Yu Lihan;Lu Qian;Xu Guangxun;Chen Hong;Tang Rui(Hepatobiliary Pancreatic Center,Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University,Tsinghua University School of Clinical Medicine,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院肝胆胰中心,北京102218 [2]清华大学临床医学院,北京102218

出　　处：《器官移植》2023年第5期708-713,共6页Organ Transplantation

基　　金：国家自然科学基金重点项目(81930119);中国医学科学院医学与健康科技创新工程创新单元(2019-I2M-5-056)。

摘　　要：目的总结肝移植术后门静脉瘤的诊疗经验。方法回顾性分析2例肝移植术后门静脉瘤患者的临床资料,结合文献复习总结其临床特点、诊断、治疗及预后。结果两例肝移植术后门静脉瘤均为肝内型,同时合并门静脉血栓、门静脉高压表现。例1患者给予针对性内科保守治疗,患者拒绝行再次肝移植手术,出院后病情加重,最终因移植肝衰竭、肾衰竭、肺部感染、感染性休克死亡。例2患者给予大剂量糖皮质激素冲击治疗,患者肝功能无改善,接受二次肝移植后恢复顺利。结论肝移植术后远期合并门静脉瘤(尤其是肝内型)可能预示预后不良,需正确认识、密切随访、积极处理,适时考虑再次肝移植是可供选择的治疗方案。Objective To summarize the diagnosis and treatment experience of portal vein aneurysm after liver transplantation.Methods Clinical data of two recipients with portal vein aneurysm after liver transplantation were retrospectively analyzed.Clinical features,diagnosis,treatment and prognosis were summarized based on literature review.Results Both two cases were diagnosed with intrahepatic portal vein aneurysm complicated with portal vein thrombosis and portal hypertension after liver transplantation.Case 1 was given with targeted conservative treatment and he refused to undergo liver retransplantation.Physical condition was worsened after discharge,and the patient eventually died from liver graft failure,kidney failure,lung infection,and septic shock.Case 2 received high-dose glucocorticoid pulse therapy,whereas liver function was not improved,and the patient was recovered successfully after secondary liver transplantation.Conclusions Long-term complication of portal vein aneurysm(especially intrahepatic type)after liver transplantation probably indicates poor prognosis.Correct understanding,intimate follow-up and active treatment should be conducted.Liver retransplantation may be a potential treatment regimen.

关 键 词：门静脉瘤 肝移植 门静脉血栓 门静脉高压 经颈静脉肝内门体静脉分流术(TIPS) 移植肝衰竭 排斥反应 再次肝移植 

分 类 号：R617[医药卫生—外科学] R543[医药卫生—临床医学]