摘要
目的探讨肝移植术后早期门静脉并发症的危险因素及诊治经验。方法回顾性分析2016年1月至2018年12月616例肝移植成人受者的临床资料,其中9例(1.5%)术后早期发生门静脉并发症。通过比较受者一般情况、供者情况及手术情况,分析发生早期门静脉并发症的危险因素。结果受者年龄、性别、供受者ABO血型是否相符、供肝冷缺血时间、移植手术耗时、术中无肝期时间、术中出血量、术中输注红细胞的量等差异均无统计学意义(P>0.05);但术前受者存在门静脉血栓、脾切除、再次肝移植和门静脉吻合方式等差异存在统计学意义,且均为发生早期门静脉并发症的危险因素(P<0.05)。二元Logistic回归分析结果显示,受者术前存在门静脉血栓(OR=16.922,95%CI为1.859~154.059,P=0.012)和再次肝移植(OR=64.871,95%CI为8.293~507.435,P<0.001)是肝移植术后早期发生门静脉并发症的独立危险因素。9例早期门静脉并发症均由超声和(或)CT血管造影证实,其中3例门静脉I型血栓受者接受口服药物治疗,3例门静脉II型血栓受者接受经腹门静脉切开取栓术和经大网膜门静脉泵植入术治疗,随访(22±14.8)个月,门静脉血流通畅;1例门静脉狭窄受者接受门静脉球囊扩张和支架植入治疗,随访17个月,门静脉血流通畅;2例门静脉血流异常受者均为再次肝移植者,术后均死亡。结论肝移植术前存在门静脉血栓和脾切除、再次肝移植和非供、受者门静脉端端吻合是肝移植术后发生早期门静脉并发症的危险因素。根据血栓类型和肝功能对门静脉血栓形成受者行个体化治疗,预后良好。应重视再次肝移植术后早期门静脉血流异常者,其死亡率较高。
Objective To explore the risk factors,diagnosis and treatment of early portal vein complications after liver transplantation.Methods From January 2016 to December 2018,clinical data of 616 adult patients undergoing liver transplantation were retrospectively analyzed.Nine cases(1.5%)had early portal vein complications.By comparing the general status of recipients and donors and the intraoperative findings,the risk factors of early portal vein complications were analyzed.Results No statistically significant differences existed in recipient age,gender,donor/recipient blood type,donor liver cold ischemia time,transplant operative duration,intraoperative non-hepatic period,intraoperative blood loss or intraoperative red blood cell transfusion(P>0.05).However,preoperative recipients had portal vein thrombosis,splenectomy,retransplantation and portal vein anastomosis.Statistical differences existed and all were risk factors for early portal vein complications(P<0.05).Binary logistic regression showed that preoperative patients had portal vein thrombosis[OR=16.922,95%CI(1.859-154.059),P=0.012]and retransplantation[OR=64.871,95%CI(8.293-507.435),P<0.001]was an independent risk factor for early portal vein complications.Nine cases of early portal vein complications were confirmed by ultrasound and/or computed tomography(CT)angiography.Three patients with portal vein thrombosis type 1 received oral medication while another three with portal vein thrombosis type 2 underwent abdominal portal vein incision,thrombectomy and large omental portal vein pump implantation.During a follow-up period of(22±14.8)months,portal vein blood flow remained patent.One patient with portal vein stenosis underwent portal vein balloon dilation and stent implantation.During a follow-up period of 17 months,portal vein blood flow remained patent.Two patients with abnormal portal vein blood flow underwent liver re-transplantation and died postoperatively.Conclusions Preoperative portal vein thrombosis and splenectomy,re-transplantation of liver and e
作者
贺英杰
温培豪
张嘉凯
王智慧
史晓奕
何玉婷
李捷
郭文治
张水军
He Yingjie;Wen Peihao;Zhang Jiakai;Wang Zhihui;Shi Xiaoyi;He Yuting;Li Jie;Guo Wenzhi;Zhang Shuijun(Department of Hepatobiliary&Pancreatic Surgery,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)
出处
《中华器官移植杂志》
CAS
北大核心
2019年第11期660-664,共5页
Chinese Journal of Organ Transplantation
基金
国家自然科学基金面上项目(81971881,U1604282)
国家自然科学基金联合基金项目(U1504804)。
关键词
肝移植
门静脉并发症
危险因素
诊断
治疗
预后
Liver transplantation
Portal complications
Risk factors
Diagnosis
Treatment
Prognosis
