CAJ | 학술논문

目的探讨介入治疗肝移植术后门静脉狭窄的价值.方法回顾性分析2005年1月至2013年3月于本院行肝脏移植术后发生门静脉狭窄并接受介入治疗的38例患者资料.所有患者均采用介入手段治疗.介入治疗后再次造影如发现胃冠状静脉仍明显扩张且影响门静脉血流,则以弹簧圈栓塞.总结临床资料、影像随访资料、介入治疗的并发症和预后等情况.结果 38例患者介入治疗的技术成功率为100％.共置入自膨式支架7枚、球囊扩张式支架29枚,覆膜支架1枚.对2例小儿肝移植患者单纯采用球囊扩张成形术治疗.共有2例患者介入治疗后胃冠状静脉明显扩张且影响门静脉血流,予以栓塞治疗.随访3～90个月.介入治疗后发生肝内血肿1例,发生率为2.63％.1例因同时合并肝动脉闭塞、缺血性胆道损伤于术后3个月死于多脏器功能衰竭.因胆道并发症接受三次肝移植1例；因门静脉主干内癌栓形成再次置入覆膜支架1例；发生支架内再狭窄1例.其余34例患者影像随访显示门静脉通畅.结论肝移植术后门静脉狭窄采用介入治疗安全、有效,远期疗效良好.
목적 탐토개입치료간이식술후문정맥협착적개치.방법 회고성분석2005년1월지2013년3월우본원행간장이식술후발생문정맥협착병접수개입치료적38례환자자료.소유환자균채용개입수단치료.개입치료후재차조영여발현위관상정맥잉명현확장차영향문정맥혈류,칙이탄황권전새.총결림상자료、영상수방자료、개입치료적병발증화예후등정황.결과 38례환자개입치료적기술성공솔위100％.공치입자팽식지가7매、구낭확장식지가29매,복막지가1매.대2례소인간이식환자단순채용구낭확장성형술치료.공유2례환자개입치료후위관상정맥명현확장차영향문정맥혈류,여이전새치료.수방3～90개월.개입치료후발생간내혈종1례,발생솔위2.63％.1례인동시합병간동맥폐새、결혈성담도손상우술후3개월사우다장기공능쇠갈.인담도병발증접수삼차간이식1례；인문정맥주간내암전형성재차치입복막지가1례；발생지가내재협착1례.기여34례환자영상수방현시문정맥통창.결론 간이식술후문정맥협착채용개입치료안전、유효,원기료효량호.
Objective To evaluate the therapeutic results of percutaneous transhepatic stent angioplasty in patients with portal vein stenosis following liver transplantation.Methods From 2005 to 2013,38 patients developed portal vein stenosis following liver transplantation.Percutaneous transhepatic angioplasty of the portal vein stenosis was performed on these patients.The results were monitored by clinical follow-up and imaging studies.Results Percutaneous transhepatic angioplasty was successful in these patients.Self-expanding metallic stents (n=7),balloon-expandable coronary stent (n=29),and membranous stent (n=1) were used.The follow-up period ranged from 3 to 90 months.Portal venous patency was maintained in 34 patients (one patient died due to multi organ failure,1 patient accepted a third liver transplantation because of biliary tract complication,and 1 patient received a repeat placement of a membranous tent because the portal vein stent was blocked by a tumor thrombus,and 1 patient developed stent restenosis).There was 1 patient who developed hemorrhage in the early postoperative period (2.63％).A diagnosis of hepatic artery hemorrhage was made by hepatic artery angiography and the patient was treated by interventional embolization.Conclusion Percutaneous transhepatic stent angioplasty is an efficacious and safe method to treat portal vein stenosis following liver transplantation.