救治原位肝移植术后早期肝动脉血栓:单中心12年经验  

Rescue of early hepatic artery thrombosis after orthotopic liver transplantation:a single center 12-year experience

作　　者：李宇[1] 张春[2] 王瑞涛[1] 刘司南 梁薛峰 王博[1] 吕毅[1] 刘学民[1] Li Yu;Zhang Chun;Wang Ruitao;Liu Sinan;Liang Xuefeng;Wang Bo;Lyu Yi;Liu Xuemin(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Surgical Intense Care Unite,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Clinical Medicine College of Yan'an University,Yan'an 716000,China)

机构地区：[1]西安交通大学第一附属医院肝胆外科,西安710061 [2]西安交通大学第一附属医院外科重症医学科,西安710061 [3]延安大学临床医学院,延安716000

出　　处：《中华器官移植杂志》2025年第1期55-62,共8页Chinese Journal of Organ Transplantation

基　　金：陕西省自然科学基础研究计划(2022JM-564);西安市科技计划(21YXYJ0109)。

摘　　要：目的探讨成人原位肝移植(orthotopic liver transplantation,OLT)受者术后早期肝动脉血栓(early hepatic arterial thrombosis,E-HAT)的治疗方式及效果。方法回顾性分析2010年1月至2022年6月西安交大一附院收治的OLT术后发生E-HAT受者的临床资料。总结E-HAT的临床特征、治疗方式及效果、受者和移植肝长期存活及远期并发症的发生情况。Kaplan-Meier法计算E-HAT受者存活率。结果2.2%(22/1016)的OLT受者术后发生E-HAT,男性19例,女性3例;年龄为(44.81±9.98)岁。经肝动脉造影确诊E-HAT的时间为OLT术后3.5(1.0,7.0)d。20例接受血管介入治疗,其中14例(70.0%)临床成功,溶栓时间为(5.1±3.2)d;12例(60.0%)术后出现并发症,其中腹腔出血10例、消化道出血1例、导管相关感染1例、皮下出血1例、肝动脉夹层1例;5例接受肝动脉再吻合术,其中2例为初诊E-HAT即手术,3例为介入治疗失败后手术。手术时间为OLT后5.0(1.0,15.3)d,其中4例手术成功。通过介入和(或)手术治疗,成功挽救81.8%(18/22)的移植肝;ALT、AST和总胆红素未明显升高和明显升高的受者成功治疗占比分别为16/18和2/4。19例存活受者的随访时间为22(5,52)个月;其中血栓复发2例;胆道并发症12例,包括缺血性胆道狭窄11例、广泛性肝坏死1例、局限性肝脓肿1例和胆道吻合口狭窄1例;因移植肝失功死亡7例。22例受者1、3、5年累积生存率分别为67.2%、60.5%、34.5%。结论联合介入、手术救治E-HAT成功率较高,在移植肝明显受损前治疗可提高治疗效果,缺血性胆道狭窄是最常见的远期并发症。Objective To investigate the treatment approaches and outcomes of early hepatic artery thrombosis(E-HAT)in adult recipients following orthotopic liver transplantation(OLT).Methods A retrospective analysis was conducted on clinical data of E-HAT cases after adult OLT at the First Affiliated Hospital of Xi'an Jiaotong University from January 2010 to June 2022.Clinical characteristics,treatment methods,therapeutic outcomes,long-term survival of recipients and grafts,and the incidence of long-term complications were summarized.The Kaplan-Meier method was utilized to calculate recipient survival rates.Results Among 1016 OLT recipients,22 cases(2.2%)developed postoperative E-HAT.There were 19 males and 3 females,with a age of 44.81±9.98 years.E-HAT was diagnosed via angiography at a median of 3.5(1.0,7.0)days post-OLT.Twenty recipients underwent vascular intervention therapy,achieving clinical success in 14 cases(70.0%)with a mean thrombolysis duration of 5.1±3.2 days.Twelve cases(60.0%)experienced complications,including abdominal bleeding(10 cases),gastrointestinal bleeding(1 case),catheter-related infection(1 case),subcutaneous bleeding(1 case),and hepatic artery dissection(1 case).Five recipients underwent hepatic artery re-anastomosis,including two initial cases and three following failed interventional therapy.Surgery was performed at a median of 5.0(1.0,15.3)days post OLT,with 4 successful cases.Through combined interventional and surgical treatment,81.8%(18/22)of grafts were salvaged.However,the success rate was significantly lower in cases with marked transaminase(AST,ALT)and total bilirubin elevation(16/18 vs 2/4).Nineteen E-HAT survivors were followed for a median of 22(5,52)months.During follow-up,2 cases experienced thrombus recurrence,and 12 cases developed biliary complications,including ischemic biliary stenosis(11 cases),extensive liver necrosis(1 case),localized liver abscess(1 case),and biliary anastomotic stenosis(1 case).Seven recipients died due to graft failure.The 1-year,3-year and 5-year cumu

关 键 词：肝移植 原位肝移植 肝动脉血栓 介入治疗 肝动脉再吻合 并发症 存活率 

分 类 号：R657.3[医药卫生—外科学]