儿童活体肝移植术后门静脉血栓的危险因素及处理  

Risk factors and treatments of portal vein thrombosis after pediatric living donor liver transplantation

作　　者：崔甘霖 董冲[2] 孙超[2] 王凯[2] 郑卫萍[2] 杨洋[2] 王振[2] 魏新哲 李林潇 李维涵 高伟[2] Cui Ganlin;Dong Chong;Sun Chao;Wang Kai;Zheng Weiping;Yang Yang;Wang Zhen;Wei Xinzhe;Li Linxiao;Li Weihan;Gao Wei(First Center Clinical College,Tianjin Medical University,Tianjin 300270,China;Department of Children's Organ Transplantation,Tianjin First Central Hospital,Tianjin Key Laboratory of Organ Transplantation,Tianjin 300192,China)

机构地区：[1]天津医科大学第一中心临床学院,天津300270 [2]天津市第一中心医院儿童器官移植科天津市器官移植重点实验室,天津300192

出　　处：《中华器官移植杂志》2024年第11期788-795,共8页Chinese Journal of Organ Transplantation

基　　金：天津市科技计划项目(21JCYBJC01130、21JCYBJC01600);天津市卫健委项目(TJWJ2022XK017);天津市医学重点学科(专科)建设项目资助。

摘　　要：目的探讨儿童活体肝移植(pediatric living donor liver transplantation,pLDLT)术后门静脉血栓形成(portal vein thrombosis,PVT)的危险因素及治疗方式。方法回顾性分析2014年1月至2021年12月在天津市第一中心医院行pLDLT手术的975例的儿童受者的临床资料,将所有病例按术后是否发生PVT分为PVT组(19例)及无PVT组(956例)。运用单因素及多因素分析筛选pLDLT受者PVT的危险因素,并探讨PVT的处理方式及预后。结果本研究975例pLDLT受者中,术后PVT总体发生率为1.9%(19/975),首次发生PVT的时间为术后8 d(1~495 d)。单因素分析显示,供者身高(P=0.014)、手术时长(P=0.002)以及间置血管(P=0.001)与pLDLT术后发生PVT有关;多因素分析显示,手术时长(P=0.008)和间置血管(P<0.01)是引起pLDLT术后PVT的独立危险因素。对于术后出现PVT的19例受者,手术取栓8例,尿激酶溶栓联合华法林抗凝治疗3例,介入治疗3例,华法林抗凝治疗4例,再移植1例。经治疗后,15例儿童受者术后PVT消失,2例PVT好转,2例发生与PVT无关的死亡事件。结论术中间置血管和手术时长是儿童活体肝移植术后PVT的独立危险因素,及时规范治疗PVT,有利于受者预后。ObjectiveTo explore the risk factors and treatments of portal vein thrombosis(PVT)in children after pediatric living donor liver transplantation(pLDLT).MethodFrom January 2014 to December 2021,the relevant clinical data were retrospectively reviewed for 975 LDLT children at Department of Pediatric Organ Transplantation of Tianjin First Central Hospital.Based upon the postoperative occurrence of PVT,they were assigned into two groups of PVT(19 cases)and non-PVT(956 cases).Univariate and multivariate analyses were performed for screening the risk factors of PVT post-LDLT and discussing the managements and prognoses of PVT.ResultAmong them,overall incidence of PVT post-LDLT was 1.9%(19/975),and median time for an initial occurrence of PVT 8(1-495)day.Single-factor analysis indicated that donor height(P=0.014),operative duration(P=0.002)and vascular interposition(P=0.001)were correlated with the occurrence of postoperative PVT post-pLDLT.Multifactorial analysis revealed that operative duration(P=0.008)and vascular interposition(P<0.01)were independent risk factors for PVT post-pLDLT.For 19 cases of postoperative PVT,the measures included surgical thrombectomy(8 cases),urokinase thrombolysis plus warfarin anticoagulation(3 cases),interventional treatment(3 cases),warfarin anticoagulation(4 cases)and retransplantation(1 cases).After treatment,the outcomes were a disappearance of PVT(15 cases),symptomatic improvement(2 cases)and unrelated mortality(2 cases).ConclusionDuring pLDLT,intraoperative placement of blood vessels and operative duration are independent risk factors for the occurrence of PVT.Timely standardized treatment may achieve satisfactory therapeutic outcomes.

关 键 词：肝移植 儿童 门静脉血栓形成 

分 类 号：R726.5[医药卫生—儿科]