摘要
目的探讨肝移植术后肝动脉并发症治疗方式与时机的选择。方法总结2003年10月至2007年3月中山大学附属第二医院肝脏移植中心25例肝移植术后肝动脉并发症的临床资料，分析介入溶栓、经皮腔内血管成形（PTA）、支架植入和再次肝移植对肝动脉并发症预后的影响。结果本组患者肝移植术后肝动脉血栓形成（hepatic artery thrombosis，HAT）5例，2例患者因肝功能衰竭行再移植治疗，术后均1字活；3例接受介入溶栓治疗后，1例肝功能恢复正常，1例死亡，1例再次出现HAT，并再次移植术后凶多器官功能衰竭死亡。术后1个月内出现肝动脉狭窄（hepatic artery stenosis，HAS）者12例，因肝功能衰竭行再移植2例；支架植入10例（治疗后因胆道缺血性改变行再移植4例）；6例再移植患者存活4例，因颅内出血和感染死亡2例。术后1个月后出现HAS者8例，行肝动脉支架植入5例，肝功能好转。因胆道缺血性改变接受再移植1例。另外2例行保守治疗，情况稳定未作处理。结论肝移植术后肝动脉并发症的治疗应根据并发症采用个体化的治疗方案。HAT的治疗以冉次肝移植为主，HAS以介入治疗为主，一旦出现胆道缺血性改变，应及时行再次肝移植。
Objective To evaluate patterns and timing of management for hepatic artery complications after orthotopic liver transplantation. Methods Between October 2003 and March 2007, the clinical data of 25 patients diagnosed as hepatic artery thrombosis （HAT） and hepatic artery stenosis （HAS） were retrospectively analyzed. Treatment patterns included liver retransplantation and interventional therapy including thrombolysis, percutaneous transluminal angioplasty and stent placement. Results There were 5 HAT cases, 3 patients were treated with thrombolysis, one patient recovered, one suffered from recurrent HAT and underwent retransplantation, and died of multiple organ failure, the third one died after thrombolysis. The remaining two HAT cases were treated with retransplantation because of liver failure and recovered. Among the 12 patients presented with HAS within 1 month posttransplantation, 2 patients received liver retransplantation because of graft failure and 10 patients were treated with interventions. 7 patients recovered after stent placement and 4 patients received late Diver retransplantaton due to ischemic bile duct lesion. Two patients died of intracranial hemorrhage and infection respectively among 6 liver retransplantations. Among the 8 patients suffering from late HAS （after 1 month postoperatively）, 5 patients were treated with stent placement, and liver function improved. Two patients were treated conservatively and liver function was stable. The remaining one patient receiving late liver retransplantation due to ischemie bile duct lesion died postoperatively. Conclusion Individualized therapeutic regimens should be adopted in treating hepatic artery complications after orthotopic liver transplanatation, according to their periods, types and whether isehemic bile duct lesion exists. Liver retransplantation is the best treatment for HAT patients.Percutaneous interventional management is the first-line therapy for patients without irreversible graft dysfunction due to HAS, but liver retransplantation is the only option for patients with ischemic bile duct lesion due to HAS.
出处
《中华普通外科杂志》
CSCD
北大核心
2008年第11期828-831,共4页
Chinese Journal of General Surgery
基金
国家科技部973计划（2003CB515500）、国家自然科学基金资助项目（30571769、30772044）、广东省科技计划项目（2004835001003、20078060401033）、广东省自然科学基金团队项目（05200177）、广东省医学科研基金（A2002164）资助
关键词
肝移植
手术后并发症
血栓形成
肝动脉狭窄
介入治疗
再移植
Liver transplantation
Postoperative complications
Thrombosis
Hepatic artery stenosis
Interventional management
Retansplantation
