血管内介入治疗肝移植术后门静脉狭窄或闭塞:5例报告

目的 观察血管内介入治疗肝移植术后门静脉狭窄或闭塞的效果。方法 对肝移植后3例门静脉狭窄及2例闭塞患者行血管内介入治疗，观察治疗效果。结果 对3例门静脉狭窄、1例门静脉闭塞行球囊扩张及支架植入术，术后造影示狭窄消失，血流通畅；对1例门静脉闭塞行球囊扩张并置管溶栓术，术后3天造影示门静脉通畅，血栓减少。1例术中发生肋间动脉出血，未见门静脉治疗相关并发症。术后4例症状逐渐消失、肝功能逐步恢复，随访期间门静脉通畅，1例支架内见少许附壁血栓；1例术后胆总管狭窄，植入胆道支架后，因重症肺炎、急性呼吸窘迫综合征、脓毒性休克死亡。结论 血管内介入治疗肝移植术后门静脉狭窄或闭塞效果良好；对移植后急性血栓形成可行球囊扩张术联合置管溶栓。

Intravascular interventional therapy for portal vein stenosis or occlusion after liver transplantation: A report of 5 cases

Objective To observe the effects of endovascular interventional therapy for portal vein stenosis or occlusion after liver transplantation. Methods Three patients with portal vein stenosis and 2 patients with portal vein occlusion after liver transplantation were treated with endovascular interventional therapy, and the effects were observed. Results Balloon dilatation and stent implantation were performed in 3 patients with portal vein stenosis and 1 patient with portal vein occlusion, and post operation venography showed that the stenosis disappeared, and the blood flow was smooth. One patient with portal vein occlusion underwent balloon dilation and catheter thrombolysis, and post operation venography showed that the portal vein was unobstructed and the thrombus decreased 3 days later. Hemorrhage of intercostal artery occurred in 1 case during operation. No other relative complication occurred. After treatment, the symptoms alleviated, and liver function gradually recovered in 4 patients. During follow-up, the portal vein remained unobstructed, but a few mural thrombi were found in stent in 1 case. Bile duct stenosis developed in 1 case after operation, then biliary stent implantation was performed, but finally the patient died of severe pneumonia, acute respiratory distress syndrome, and septic shock. Conclusion Intravascular interventional therapies were effective for portal vein stenosis or occlusion after liver transplantation. Balloon dilatation combining with catheter thrombolysis could be used for treating acute thrombosis.