【摘要】 目的探讨肝移植术后肝静脉流出道梗阻(HVO)的介入治疗方法及临床效果。方法回顾性分析5例肝移植术后(劈离式肝移植2例,活体肝移植3例)发生HVO,实施支架植入(4例)和经皮腔内血管成形术(1例)患者的临床资料和介入技术要点。结果介入治疗3例采取经皮肝穿刺肝静脉入路,2例采取右颈内静脉入路。肝静脉造影显示HVO发生在肝左或肝右静脉与下腔静脉吻合口3例,在肝总静脉与肝右静脉吻合口2例。5例介入治疗均成功,介入术后肝静脉与右心房间压力梯度从(15.4±5.6)mmHg下降到(1.9±1.2)mmHg。术后随访9～482d,无一例发生再狭窄。术后1例因多器官功能衰竭死亡,4例术前明显升高的血清转氨酶和(或)胆红素术后均恢复正常。术前伴有大量腹水、消化道出血的2例术后腹水均缓解,消化道出血停止。结论HVO是肝移植术后少见并发症,危害严重,介入治疗是其安全、有效的治疗方法。更多还原

【Abstract】 Objective To discuss the technique and efficacy of interventional management for the treatment of hepatic venous outflow obstruction (HVO) after liver transplantation. Methods The clinical data of 5 patients with HVO developed after liver transplantation, including split (n = 2) and living donor (n = 3) liver transplantation, were retrospectively analyzed. Stent placement was performed in 4 cases and percutaneous transluminal angioplasty in one case. The technical points of interventional management were discussed. Results Interventional management was performed via the percutaneous hepatic vein approach in 3 patients and via the right internal jugular venous access in 2 patients. Judged from hepatic venography, the location of HVO was at the anastomotic stoma of left-or right-hepatic vein with inferior vena cava (n = 3) or at the anastomotic stoma of middle hepatic vein with right hepatic vein (n = 2). Interventional technical success was achieved in all 5 patients. After the procedure, the venous pressure gradient, i.e. the blood pressure difference between the hepatic artery and the right atrium, was significantly reduced from (15.4 ± 5.6)mmHg to(1.9 ± 1.2) mmHg. During the follow-up period of 9 -482 days, no restenosis was found on Doppler sonographic manifestations. The liver enzyme and / or bilirubin which were markedly elevated before procedure returned to normal after the procedure in 4 patients except one patient who died of multiple-organs failure at the 9th day after the treatment. In two patients with large quantity of ascites and upper digestive tract bleeding, the ascites receded and the bleeding stopped after the procedure. Conclusion Hepatic venous outflow obstruction is a rare, but potentially fatal, complication after liver transplantation and interventional management with stent placement or percutaneous transluminal angioplasty is an effective and safe treatment for it.更多还原