门静脉血栓分型与肝移植门静脉重建策略探讨  

Exploring the classification of portal vein thrombosis and portal vein reconstruction strategies in liver transplantation

作　　者：罗星玉 杨喆 郑树森 Luo Xingyu;Yang Zhe;Zheng Shusen(Graduate School,Zhejiang Chinese Medical University,Hangzhou 310053,China;Department of Hepatobiliary and Pancreatic Surgery,Shulan(Hangzhou)Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College,Hangzhou 310015,China)

机构地区：[1]浙江中医药大学研究生院,杭州310053 [2]浙江树人大学树兰国际医学院附属树兰(杭州)医院肝胆胰外科,杭州310015

出　　处：《中华移植杂志（电子版）》2023年第6期372-380,共9页Chinese Journal of Transplantation(Electronic Edition)

基　　金：国家自然科学基金(92159202);浙江省重点研发计划项目(2023C03046);浙江省自然科学基金项目(Y21H160259);海南省重大科技计划(ZDKJ2019009);济南微生态生物医学省实验室科研项目(JNL-2022016B);中央高校基本科研业务费专项资金资助项目(2022ZFJH003)。

摘　　要：非肿瘤性门静脉血栓形成(PVT)是晚期肝硬化等待肝移植患者的严重并发症之一,且会影响移植后结局.目前虽已有众多学者提出多种PVT分级方法,但许多分级方法对于如何利用门体侧支循环进行吻合却没有详细定论,这使得PVT的治疗和肝移植术中门静脉重建更加困难和复杂.充足的门静脉血流是保证肝移植术后受者及移植物存活的重要因素.对于非复杂性Yerdel 1~3级PVT患者可术中行门静脉血栓切除术及解剖吻合达到生理性重建;而对于复杂性Yerdel 4级PVT,可能须利用内脏曲张静脉、肾静脉进行门静脉血流重建,有时甚至须行腔门静脉吻合、门静脉动脉化或多脏器联合移植.本文综述国内外最新PVT分型、生理与非生理性门静脉重建的定义、术中门静脉吻合方式及PVT围术期管理,以期为临床上制订合理的门静脉重建方案提供参考.Non-tumoral portal vein thrombosis(PVT)is a significant complication in patients with advanced cirrhosis waiting for liver transplantation,and can impact post-transplant outcomes.Although many scholars have proposed various PVT classification methods,many classifications have no detailed conclusion on how to use the portosystemic collateral circulation for anastomosis,which makes the treatment of PVT and portal vein reconstruction during liver transplantation more difficult and complex.Adequate portal vein flow plays a crucial role in ensuring the recipient's and graft's survival after liver transplantation.Intraoperative portal vein thrombectomy and anatomic anastomosis can achieve physiologic reconstruction in patients with uncomplicated Yerdel grade 1-3 PVT,while for complex Yerdel grade 4 PVT may need portal vein revascularization using visceral varicose veins,renal vein,and sometimes even cavoportal anastomosis,portal vein arterialization,or combined with multiple organs transplantation.Therefore,this article aims to review the latest domestic and international staging of PVT,definition of physiological and non-physiological portal vein reconstruction,intraoperative portal vein anastomosis modalities,and perioperative management of PVT,hoping to provide a clinical reference for portal vein reconstruction protocols.

关 键 词：肝移植 门静脉血栓形成 门静脉重建 围手术期管理 

分 类 号：R657.3[医药卫生—外科学]