CAJ | 학술논문

目的：探讨儿童肝移植术后急性肝动脉血栓（HAT）形成的诊断与治疗，及其对患儿预后的影响。方法自2012年1月至2013年8月天津市第一中心医院肝移植术后急性HAT患儿3例，2例患儿行肝动脉重新吻合及取栓治疗；1例行动脉内溶栓、经皮腔内血管成形术（PTA）及支架治疗。对患者临床资料、影像随访资料、介入治疗的并发症和预后等情况进行总结。结果3例肝移植患儿出现急性HAT形成，均经血管造影证实，发生时间分别为术后第2天、第6天和第10天。2例患儿行肝动脉重新吻合及取栓手术，其中1例出现肝脓肿，经穿刺引流治愈；另1例患儿未出现并发症。1例患儿行肝动脉内溶栓、球囊扩张和内支架治疗；术后3个月出现缺血性胆管并发症，经T管窦道网篮取胆泥和置管治疗。随访所有患儿肝功能正常，超声示肝动脉血流通畅。结论肝移植术后常规超声监测肝动脉血流是早期发现HAT的关键，肝动脉造影可明确诊断；及时采用介入治疗、手术治疗可减少患儿及移植物失功能。
목적：탐토인동간이식술후급성간동맥혈전（HAT）형성적진단여치료，급기대환인예후적영향。방법자2012년1월지2013년8월천진시제일중심의원간이식술후급성HAT환인3례，2례환인행간동맥중신문합급취전치료；1례행동맥내용전、경피강내혈관성형술（PTA）급지가치료。대환자림상자료、영상수방자료、개입치료적병발증화예후등정황진행총결。결과3례간이식환인출현급성HAT형성，균경혈관조영증실，발생시간분별위술후제2천、제6천화제10천。2례환인행간동맥중신문합급취전수술，기중1례출현간농종，경천자인류치유；령1례환인미출현병발증。1례환인행간동맥내용전、구낭확장화내지가치료；술후3개월출현결혈성담관병발증，경T관두도망람취담니화치관치료。수방소유환인간공능정상，초성시간동맥혈류통창。결론간이식술후상규초성감측간동맥혈류시조기발현HAT적관건，간동맥조영가명학진단；급시채용개입치료、수술치료가감소환인급이식물실공능。
Objective To evaluate the diagnosis and treatment of hepatic artery thrombosis(HAT)after pediatric liver transplantation. Methods From January 2012 to August 2013,there were 3 children with HAT. 1 patient experienced interventional therapy with thrombolysis,percutaneous transluminal angioplasty(PTA)and stent. 2 patients underwent emergent hepatic artery revascularization combined with intra-arterial embolectomy. The therapeutic results were monitored by clinical follow-up and imaging examination. Results 3 children developed HAT on 2,6 and 10 days after operation,respectively. 2 children underwent emergent operation;1 child developed hepatic abscess and cured by puncture drainage;another child didn't experience any complications. 1 patient who performed interventional therapy,appeared ischemic biliary complications in 3 months after operation,and was treated with basket catheter from T-tube approach and drainage tube. All children were with normal liver function, hepatic artery patency on ultrasound. Conclusions It is essential to diagnose HAT by monitoring the artery flow by Doppler ultrasound screening in the early period after operation. Interventional therapy and emergent hepatic artery revascularization are effective rescue treatments.