肝移植术后晚期门静脉闭塞介入治疗研究  

Interventional treatment of advanced portal vein occlusion after liver transplantation

作　　者：刘恩成 陈光[1] 高海军[1] 王浩[1] 焦义龙 Liu Encheng;Chen Guang;Gao Haijun;Wang Hao;Jiao Yilong(Department of Radiology,Tianjin First Central Hospital,Tianjin Institute of Imaging Medicine,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院放射介入科、天津市影像医学研究所,天津300192

出　　处：《中华肝胆外科杂志》2023年第11期808-812,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-041A)。

摘　　要：目的探讨肝移植术后晚期门静脉闭塞不同门静脉闭塞分级介入治疗的有效性、安全性。方法回顾性分析2016年3月至2022年6月天津市第一中心医院肝移植术后晚期门静脉闭塞患者资料。共入组13例患者,其中男性8例,女性5例,年龄范围2~68岁,中位年龄47岁。基于门静脉血栓Yerdel分级和天津市第一中心医院放射介入科介入诊治经验,进一步优化门静脉闭塞分级,并依据分级行不同治疗。观察患者门静脉闭塞两端压力梯度变化、介入并发症、介入术后门静脉通畅情况等。结果13例患者均获得介入治疗技术成功。13例患者置入支架共15枚。介入手术时间(63.1±18.4)min。13例患者介入治疗前门静脉闭塞两端压力梯度为[M(Q_(1),Q_(3))]14.0(9.5,18.0)mmHg(1 mmHg=0.133 kPa),高于介入治疗后压力梯度[M(Q_(1),Q_(3))]1.0(1.0,2.5)mmHg,差异有统计学意义(Z=-3.19,P<0.001)。1例患者于介入术后6 d再发门静脉主干及门静脉右支内血栓,再次介入治疗后好转。1例患者于介入术后111 d因门静脉主干内再次血栓形成行经颈静脉肝内门体分流术,其余患者介入术后随访过程中门静脉均通畅。所有患者均未发生穿刺点及腹腔内出血等介入相关并发症。结论基于不同门静脉闭塞分级采取相应的介入治疗肝移植术后晚期门静脉闭塞安全、可行。Objective To evaluate the efficacy and safety of interventional treatment of advanced portal vein occlusion indifferent stages after liver transplantation.Methods The clinical data of 13 patients with advanced portal vein occlusion after liver transplantation in Tianjin First Central Hospital from March 2016 to June 2022 were retrospectively analyzed,including 8 males and 5 females,with a median age of 47(2 to 68)years.Based on the Yerdel’s Classification of portal vein thrombosis and Department of Radiology,Tianjin First Central Hospital practice experience,the classification of portal vein occlusion was further modified for a classification-base interventional treatment.The changes of portal vein pressure gradient,complications and protal vein after interventional treatment were analyzed.Results All 13 cases underwent successful interventional treatment.A total of 15 stents were implanted in the 13 patients.The treatment time was(63.1±18.4)min.The pressure gradient at both ends of portal vein occlusion before treatment was[M(Q_(1),Q_(3))]14.0(9.5,18.0)mmHg(1 mmHg=0.133 kPa),which declined after interventional treatment 1.0(1.0,2.5)mmHg(Z=-3.19,P<0.001).Portal vein and right portal branch thrombosis recurred in one patient six days after interventional treatment,which was managed with re-interventional treatment.One patient underwent intrahepatic portal shunt through jugular vein 111 days after interventional treatment due to recurrent portal vein thrombosis.The other patients recovered uneventfully without recurrent portal vein thrombosis or occlusion during follow-ups.No intervention-related complications such as puncture point and intraperitoneal hemorrhage occurred in the patients.Conclusion A modified classification-based interventional treatment could be safe and feasible for patients with advanced portal vein occlusion after liver transplantation.

关 键 词：肝移植 晚期门静脉闭塞 介入治疗 

分 类 号：R657.3[医药卫生—外科学]