CAJ | 학술논문

目的探讨肝移植术中门静脉血栓的几种处理方法及其疗效.方法回顾性分析773例次肝移植临床资料.773例中,107例病人有门静脉血栓,其中59例Ⅰ级;33例Ⅱ级;12例Ⅲ级;3例Ⅳ级.Ⅰ、Ⅱ级组行血栓切除或取栓术;Ⅲ级采用取栓术或肠系膜上静脉架桥的方式重建供肝门静脉;对Ⅳ级采用改良门腔静脉半转位术和门静脉胃冠状静脉吻合重建供肝门静脉.结果 Ⅰ、Ⅱ级组移植肝功能恢复良好,围手术期病死率为4.3%.Ⅲ级取栓组5例肝功能恢复良好,围手术期无死亡.静脉架桥组7例中有2例肝功能恢复不佳,围手术期病死率为28.6%.Ⅳ级组肝功能恢复良好,围手术期无死亡.结论门静脉血栓已非肝移植禁忌证,根据血栓的不同情况采取合理的手术方式重建门脉系统可以获得良好的治疗效果.
목적 탐토간이식술중문정맥혈전적궤충처리방법급기료효.방법 회고성분석773례차간이식림상자료.773례중,107례병인유문정맥혈전,기중59례Ⅰ급;33례Ⅱ급;12례Ⅲ급;3례Ⅳ급.Ⅰ、Ⅱ급조행혈전절제혹취전술;Ⅲ급채용취전술혹장계막상정맥가교적방식중건공간문정맥;대Ⅳ급채용개량문강정맥반전위술화문정맥위관상정맥문합중건공간문정맥.결과 Ⅰ、Ⅱ급조이식간공능회복량호,위수술기병사솔위4.3%.Ⅲ급취전조5례간공능회복량호,위수술기무사망.정맥가교조7례중유2례간공능회복불가,위수술기병사솔위28.6%.Ⅳ급조간공능회복량호,위수술기무사망.결론 문정맥혈전이비간이식금기증,근거혈전적불동정황채취합리적수술방식중건문맥계통가이획득량호적치료효과.
Objective To investigate the surgical options for the management of portal vein thrombosis (PVT) during liver transplantation and its impact on the outcome of patients. Methods 773 cases of liver transplantation were analyzed retrospectively. PVT occurred in 107 patients, inclu-ding 59 of grade Ⅰ ,33 of grade Ⅱ, 12 of grade Ⅲ and 3 of grade Ⅳ. Simple thrombectomy or thrombus-extraction was performed in grade Ⅰ and Ⅱ. 12 patients with grade Ⅲ received thrombus-extraction or using the donor iliac vein to act as a bridge between the donor portal vein and host superior mesenteric vein. Two cases of grade Ⅳ received a modified cavo-portal hemitransposition and one case received portal-vena coronaria varication anastomosis. Results Liver function had a good recover and the perio-perative mortality is 4. 3% in grade Ⅰ and Ⅱ. In grade Ⅲ , 5 cases received thrombus-extraction had a normal liver function after transplantation and had no died. 2 cases among the other 7 cases using por-tal vein reconstruction had bad liver function and died. The liver function recovered well after trans-plantation and there was no died in grade Ⅳ. Conclusions PVT is not a contraindication for liver transplantation. Good results can be obtained by applying reasonable operative procedures individually.