中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2009年
6期
489-491
,共3页
肝移植%门体分流术,外科%静脉血栓形成
肝移植%門體分流術,外科%靜脈血栓形成
간이식%문체분류술,외과%정맥혈전형성
Liver transplatation%Portasystemic shunt,surgical%Veinous thrombosis
目的 通过原位肝移植术中结扎经CT确认的粗大的门体分流静脉,探讨结扎该分流静脉的临床意义.方法 根据天津市第一中心医院移植外科2007年1月1日至2008年8月1日原位肝移植术前三维CT检杳35例中,12例无门体分流静脉,23例存在明确的门体分流静脉,并应用门静脉血流仪在术中行门静脉血流量测定,根据测量结果,其中7例未行分流静脉结扎,16例行门体分流静脉结扎.结果 本组中12例无门体静脉分流者的门静脉血流量是(1101±70)ml/min.23例有门体分流静脉中,7例门静脉血流量>1000 ml/min者未行分流静脉结扎,16例血流馈<1000 ml/min者行分流静脉结扎.16例结扎前后门静脉血流量分别是(657±112) ml/min和(1136±161) ml/min,结扎前后门静脉血流量相比差异有统计学意义(P<0.05).本组23例均获得随访,其中19例正常存活,移植物功能良好,血流正常.有2例术后门静脉血栓复发(经抗凝治疗后好转),其中1例出现间断性意识障碍,血氨水平波动在126～194 mmol/L之间,给予降血氨治疗后好转.2例在术后3个月内死亡,其中1例在术后1.5个月因肺部曲霉菌感染导致呼吸功能衰竭死亡,另1例在术后2个月因移植物功能不良导致肝功能衰竭而死亡. 结论原位肝移植术中结合三维CT扫描血管重建及血流动力学数据,结扎门体分流静脉是有意义的.
目的 通過原位肝移植術中結扎經CT確認的粗大的門體分流靜脈,探討結扎該分流靜脈的臨床意義.方法 根據天津市第一中心醫院移植外科2007年1月1日至2008年8月1日原位肝移植術前三維CT檢杳35例中,12例無門體分流靜脈,23例存在明確的門體分流靜脈,併應用門靜脈血流儀在術中行門靜脈血流量測定,根據測量結果,其中7例未行分流靜脈結扎,16例行門體分流靜脈結扎.結果 本組中12例無門體靜脈分流者的門靜脈血流量是(1101±70)ml/min.23例有門體分流靜脈中,7例門靜脈血流量>1000 ml/min者未行分流靜脈結扎,16例血流饋<1000 ml/min者行分流靜脈結扎.16例結扎前後門靜脈血流量分彆是(657±112) ml/min和(1136±161) ml/min,結扎前後門靜脈血流量相比差異有統計學意義(P<0.05).本組23例均穫得隨訪,其中19例正常存活,移植物功能良好,血流正常.有2例術後門靜脈血栓複髮(經抗凝治療後好轉),其中1例齣現間斷性意識障礙,血氨水平波動在126～194 mmol/L之間,給予降血氨治療後好轉.2例在術後3箇月內死亡,其中1例在術後1.5箇月因肺部麯黴菌感染導緻呼吸功能衰竭死亡,另1例在術後2箇月因移植物功能不良導緻肝功能衰竭而死亡. 結論原位肝移植術中結閤三維CT掃描血管重建及血流動力學數據,結扎門體分流靜脈是有意義的.
목적 통과원위간이식술중결찰경CT학인적조대적문체분류정맥,탐토결찰해분류정맥적림상의의.방법 근거천진시제일중심의원이식외과2007년1월1일지2008년8월1일원위간이식술전삼유CT검묘35례중,12례무문체분류정맥,23례존재명학적문체분류정맥,병응용문정맥혈류의재술중행문정맥혈류량측정,근거측량결과,기중7례미행분류정맥결찰,16례행문체분류정맥결찰.결과 본조중12례무문체정맥분류자적문정맥혈류량시(1101±70)ml/min.23례유문체분류정맥중,7례문정맥혈류량>1000 ml/min자미행분류정맥결찰,16례혈류궤<1000 ml/min자행분류정맥결찰.16례결찰전후문정맥혈류량분별시(657±112) ml/min화(1136±161) ml/min,결찰전후문정맥혈류량상비차이유통계학의의(P<0.05).본조23례균획득수방,기중19례정상존활,이식물공능량호,혈류정상.유2례술후문정맥혈전복발(경항응치료후호전),기중1례출현간단성의식장애,혈안수평파동재126～194 mmol/L지간,급여강혈안치료후호전.2례재술후3개월내사망,기중1례재술후1.5개월인폐부곡매균감염도치호흡공능쇠갈사망,령1례재술후2개월인이식물공능불량도치간공능쇠갈이사망. 결론원위간이식술중결합삼유CT소묘혈관중건급혈류동역학수거,결찰문체분류정맥시유의의적.
Objective To investigate the clinical significance of ligating the portasystemic shunt confirmed by preoperative CT evaluation during orthotopic liver transplantation. Methods From January 2007 to August 2008, 35 patients in Tianjin First Central Hospital underwent preoperative three-dimensional CT scan, among them 23 patients had spontaneous major portasystemic shunts, the other 12 patients did not have portasystemic shunts. 16 out of the 23 cases with significant shunts underwent shunt ligation based on portal blood flow volume measured by intraoperative portal vein flowmetry. The shunt of the other 7 patients were left untreated. Results The portal blood flow in the 12 patients without portasystemic shunt as judged by preoperative CT scanning were (1101±70) ml/min. The shunts in 7 patients with portal blood flow greater than 1000 ml/min were not ligated, that of the 16 patients with portal blood flow volume lower than 1000 mL/min were ligated. The portal blood flow volume in those 16 patients before and after ligating the shunt were (657±112) m//min and (1136±161) ml/min, respectively (P<0.05). Postoperatively 2 patients suffered from portal vein thrombosis, among them 1 patient suffered from intermittent disturbance of consciousness, 2 patients died within 3 months, with one dying of respiratory failure from pulmonary aspergillus infection one dying of hepatic failure in 2 months after operation because of graft dysfunction.The other 19 patients with normal blood flow and well-functioning graft were alive. Conclusion The ligation of portasystemic shunt is mandatory in patients when pretransplant CT evaluation showing a major porto-systemic shunts and portal blood flow volume was less than 1000 ml/min.
