肝移植术后并发症与介入治疗四、门静脉并发症

肝移植术后门静脉供血障碍性并发症主要为门静脉狭窄和门静脉血栓形成,虽然发生率不高,但临床危害大,一经确诊,需积极处理。彩色多普勒血流显像可作为检测门静脉血流的首选方法,对确诊有功能意义的狭窄还需依赖血管造影。对于门静脉狭窄行球囊扩张术以及支架置入术可有效降低门脉压力,而门静脉血栓形成的病例可用药物溶栓、机械碎栓和支架置放术相结合进行治疗,必要时可行TIPS降低门脉压力。

Interventional therapy of complications after liver transplantation:complications of portal vein

The insufficient blood supply to the portal vein after liver transplantation, mainly caused by portal vein stenosis (PVS)or portal vein thrombosis(PVT), occurs low in incidence but would be serious enough to lead to graft failure. Prompt diagnosis and treatment is critical to allow graft salvage. The color Doppler flow image (CDFI) could be the first choice for testing portal venous flow, and angiography is reliable for further accurate diagnosis on meaningful functional change of the stenosis. The interventional therapy , including percutaneous balloon angioplasty and stent placement, is safe and effective in lowering the portal venous pressure after hepatic transplantation with portal vein stenosis. Thrombolysis, percutaneous mechanical fragmentation and stent placement ,as the treatments of early portal vein thrombosis, are effective therapeutic methods, and TIPS is also a proper management if necessary.