CAJ | 학술논문

目的总结分析肝移植中门静脉血栓(PVT)的处理经验以及PVT对肝移植术后疗效的影响.方法总结1995年5月至2007年9月194例接受肝移植手术的患者的临床资料,其中术前存在PVT 24例(12.4%),Ⅰ级12例、Ⅱ级9例、Ⅲ级2例、Ⅳ级1例.根据血栓程度分级采取不同的方式进行门静脉重建.术后根据凝血酶原时间(PT),应用普通肝素或低分子肝素预防性抗凝.术后应用多普勒超声监测门静脉血供.选取同期接受肝移植手术的无PVT的170例患者作为对照组,比较两组手术过程和预后的差别.结果 21例Ⅰ级、Ⅱ级血栓患者行血栓切除术,2例Ⅲ级血栓患者行髂静脉-肠系膜上静脉搭桥,1例Ⅳ级血栓患者将供肝门静脉和受者粗大的门静脉属支吻合.有PVT组比无PVT组手术时间和住院时间长,输血量多,术后PVT的再发率高(P<0.05),但并发症发生率、围手术期病死率和术后1年生存率两组间无差别(P>0.05).PVT组有2例术后血栓再发,经放射介入治疗治愈.结论术前PVT的存在增加了肝移植手术的难度和术后PVT的再发率,但对肝移植的预后没有影响.
목적 총결분석간이식중문정맥혈전(PVT)적처리경험이급PVT대간이식술후료효적영향.방법 총결1995년5월지2007년9월194례접수간이식수술적환자적림상자료,기중술전존재PVT 24례(12.4%),Ⅰ급12례、Ⅱ급9례、Ⅲ급2례、Ⅳ급1례.근거혈전정도분급채취불동적방식진행문정맥중건.술후근거응혈매원시간(PT),응용보통간소혹저분자간소예방성항응.술후응용다보륵초성감측문정맥혈공.선취동기접수간이식수술적무PVT적170례환자작위대조조,비교량조수술과정화예후적차별.결과 21례Ⅰ급、Ⅱ급혈전환자행혈전절제술,2례Ⅲ급혈전환자행가정맥-장계막상정맥탑교,1례Ⅳ급혈전환자장공간문정맥화수자조대적문정맥속지문합.유PVT조비무PVT조수술시간화주원시간장,수혈량다,술후PVT적재발솔고(P<0.05),단병발증발생솔、위수술기병사솔화술후1년생존솔량조간무차별(P>0.05).PVT조유2례술후혈전재발,경방사개입치료치유.결론 술전PVT적존재증가료간이식수술적난도화술후PVT적재발솔,단대간이식적예후몰유영향.
Objective To summarize the experience in the managements of portal vein thrombosis (PVT) and to evaluate the impact of PVT on intraoperative course and postoperative outcome in liver transplantation. Methods Between May 1995 and September 2007, 194 orthotopic liver transplantations were performed,of which 24 cases presented portal vein thrombosis. There were 12 patients with grade Ⅰ ,9 with grade Ⅱ,2 with grade Ⅲ and 1 with grade Ⅳ. The management of PVT depended mainly on its extent. Ligation of the collateral circulation, especially spontaneous or surgical splenorenal shunt, was made as approaches to improve portal flow. Heparin or low-molecule-weight heparin as a prophylactic anticoagulation therapy was maintained during and after operation if prothrombin time is less than eighteen seconds. Follow-up Doppler ultrasonography was used daily in the early postoperative period. Risk factors and variables associated with the transplant and the post-transplant period were analyzed and compared with 170 patients transplanted without PVT. Results Surgical techniques were eversion thromboendovenectomy in 21 patients with PVT grades Ⅰ and Ⅱ, extra-anatomic mesenterie graft in 2 with grade Ⅲ, and anastomosis to a collateral vein in 1 with grade Ⅳ. The study demonstrated more RBC transfusions [(15.2 ± 11.8) U vs. (8.6±6.6) U,P =0.006] ,longer surgery procedures[(492±89)rain vs. (403 ± 105)min,P =0.001] and hospital stay [(32. 4 ± 13.5)d vs. (22. 1±9. 1)d,P =0. 001] in the PVT group. However,there were no differences in overall morbidity(58. 3% vs. 50. 6% ,P =0. 478) ,hospital mortality(8. 3% vs. 6. 5% ,P = O. 73) and 1-year survival(87. 5% vs. 89. 4% ,P=0. 778). The incidence of rethrombosis was higher in the PVT group(8.3% vs. 1.2%, P = 0. 021). Two cases rethrombnsis were successfully cured by percutanous thrombolysis,ballcon angioplasty, and stent placement. Conclusion Portal thrombosis is associated with greater operative complexity and rethrombosis,but has no influence on overall morbidity and mortality in liver transplantation.