摘要
目的对不同门静脉重建方式预防小儿肝移植术后门静脉血栓及狭窄的经验进行总结。方法从2006年9月至2014年3月本院单中心对175例终末期肝病患儿实施了肝移植手术。受者年龄4.5个月～12岁，平均（16.16±19.77）个月。对受者术后进行1～93个月随访并收集数据，统计分析受体1、3、5年生存率、术后门静脉血管并发症的发生比例、手术方式等相关因素。结果175例患儿中126例采取供体门静脉与受体门静脉左右支分叉部静脉片吻合，2例采取供体门静脉与受体脾静脉与肠系膜上静脉汇合部吻合，5例采取受体髂静脉血管搭桥术，术后均未出现门静脉狭窄，肝功能恢复良好；42例采取供受体门静脉端端吻合，出现门静脉血栓形成2例（1.14%），其中亲属活体肝移植1例，劈离式肝移植1例，经皮经肝门静脉球囊扩张术后治愈。其他并发症包括肝动脉闭塞5例（2.9%），术后胆漏5例（2.9%），术后肠漏3例（1.7%），急性排斥反应7例（4.0%），胆道并发症9例（5.1%），机会性感染115例（65.7%）。随访1～93个月，175例患儿中死亡14例，7例为多器官功能衰竭，6例为严重肺感染，1例死于肝动脉破裂出血。总体5年生存率为93.1%，3年生存率为94.7%，1年生存率为95.5%。结论小儿肝移植术中根据供受体门静脉直径匹配程度及长度情况选取适当门静脉重建方式具备可行性，对于预防肝移植术后门静脉狭窄及血栓形成具有重要作用。
Objective To summarize the variety of portal vein reconstruction to prevent portal vein thrombosis and stenosis in pediatric liver transplant recipients. Methods From September 2006 to March 2013, we performed 175 liver transplantations for children with end-stage liver diseases. Recipients were from 4.5 months to 12 years old,average(16.16±19.77)months. The recipients were followed up from 1 to 93 months and data were collected. 1,3 and 5-year survival rate,incidence of postoperative complications of portal vein,surgical technique and other relevant factors were analyzed. Results Of the 175 patients,donor portal vein to recipient portal vein branch bifurcation vein segment anastomosis were performed in 126 cases,donor portal vein to recipient confluence of superior mesenteric vein and splenic vein in 2 cases,and donor iliac vein bypass grafts were used in 5 cases. Postoperative portal vein stenosis were not observed,and liver function recovered well. Among 42 patients underwent end-to-end portal vein anastomosis,2 cases suffered portal vein thrombosis(1.14%),one with living donor liver transplantation and the other with split liver transplantation,which were successfully treated with percutaneous transhepatic portal vein angioplasty. Other complications included hepatic artery occlusion in 5 cases(2.9%),bile leakage in 5 cases(2.9%),postoperative intestinal leakage in 3 cases(1.7%),acute rejection in 7 cases(4.0%), biliary complications in 9 patients(5.1%),and opportunistic infections in 115 cases(65.7%). Among 175 cases of pediatric recipients with follow-up from 1 to 93 months patients,14 cases died,with 7 cases of multiple organ failure, 6 cases of severe lung infection,one case of hepatic arterial bleeding. The overall 1,3,5-year survival rates were 95.5%,94.7%,and 93.1% respectively. Conclusion Selection of appropriate way of portal vein reconstruction according to matching donor and recipient portal vein diameter and length is feasible and plays an important role on the prevention of pediatric liver trans
出处
《实用器官移植电子杂志》
2014年第5期279-282,共4页
Practical Journal of Organ Transplantation(Electronic Version)
基金
国家高技术研究发展计划(863)项目(2012AA021001)
天津市科技计划项目(12ZCZDSY02600)
关键词
肝移植
小儿
门静脉重建
Liver transplantation
Pediatric
Portal vein reconstruction
