肝移植术后门静脉阻塞的介入治疗

目的 评价用介入技术治疗原位肝移植术后门静脉(PV)阻塞的安全性和疗效.方法 对13例原位肝移植术后PV阻塞[狭窄和(或)血栓形成]病人进行了介入治疗,男9例,女4例;年龄28～60岁(平均43岁).其中PV血栓3例,PV吻合口狭窄9例,PV吻合口狭窄合并血栓1例,合并食管-胃底静脉曲张9例(其中8例有呕血病史).7例用经皮经肝穿刺PV分支途径治疗,6例经TIPS途径,技术包括球囊扩张+置入支架8例、局部溶栓和清除血栓4例次、单纯球囊扩张2例、联合栓塞胃冠状静脉9例次.结果 介入治疗技术均成功,无重要并发症,结束治疗时复查造影显示PV血流通畅,PV主干管径接近正常10例、3例残留狭窄＜30%.随访6～48个月(平均28个月),5例术前肝功能异常病人,术后2周有显著改善;9例以门静脉高压症合并食管-胃底静脉曲张病人,术后复查胃镜显示静脉曲张明显好转,随访期间未发生静脉曲张破裂出血.4例腹部症状较明显的病人,术后腹痛、腹胀和腹泻等症状逐渐减轻;复查Doppler超声波显示PV血流通畅.结论 介入技术是治疗原位肝移植术后PV阻塞的安全、有效方法 .

Interventional Therapy of Portal Vein Occlusion after Liver Transplantation

Objective To evaluate the safety and efficacy of the interventional radiological techniques for management of portal vein occlusion after orthotopic liver transplantation.Methods 13 patients with PV occlusion(stenosis and/or thrombosis)after orthotopic liver transplantation were treated by interventional procedures.The patients were nine males and four females.They ranged from 28 to 60 years old(average age was 43).Three patients presented with PV thrombosis,nine presented PV anastomotic stoma stenosis,one presented PV thrombosis and PV anastomotic stoma stenosis,nine associated with esophagogastric varices(eight of them have experiences of hematemesis).The portal access was established via a percutaneous transhepatic route in seven patients,and via a transjugular intrahepatic portosystemic shunt(TIPS)approach in six.The interventional procedures included balloon angioplasty and stent placement in eight patients,catheter directed pharmacologic and mechanical thrombolysis for four times,balloon angioplasty in two patients,and associated with embolism of esophagogastric varices for nine times.Results The technical Success was achieved in all cases.No complications relating to the procedure occurred.Angiography re-examination indicated that portal blood flow was reestablished in all patients after the procedures.PV trunk's diameter was almost normal in 10 patients,and remaining stenosis was less than 30 percent of normal diameter in three patients.Follow-up time ranged from 6 to 48 months(average 28 months).Five patients'liver function improved apparently two weeks after the interventional therapy.Gastroscopy showed esophagogastric varices improved apparently in nine patients with portal hypertension and esophagogastric varices,and bleeding from esophagogastric varices did not occur after the interventional therapy.Clinical improvement was seen in four patients with symptomatic abdomen,characterized by progressive reduction of abdominal pain.distention,and diarrhea.Doppler US re-examination showed that PV's blood flow was normal.Conclusions Interventional radiological techniques are safe and effective in the treatment of portal vein occlusion after orthotopic liver transplantation.