肝移植术后肝动脉血栓形成的诊治经验分析

目的 总结肝脏移植术后肝动脉血栓形成的预防、诊断及治疗经验。方法回顾性分析1993年4月至2003年9月完成的198例肝脏移植的临床资料。96例采用肝动脉连续吻合法(第1组),102例采用肝动脉间断吻合方法(第2组)。术后常规以多普勒超声监测肝动脉血流。结果第1组有6例术后发生肝动脉血栓形成,发生率为6．3％(6／96);第2组有1例发生肝动脉血栓形成,发生率为1．0％(1／102),显著低于1组(x^2=4．027,P=0．045)。在这7例发生肝动脉血栓形成的患者中,除1例为术后剖腹探查发现外,6例均为彩色超声检查发现。其中6例行急诊肝动脉取栓术,重建肝动脉血流。取栓术后,3例发生严重的胆道并发症,其中2例已死亡,1例需接受再次肝移植;另3例中,1例死于肾功能衰竭,2例健康存活至今。另外1例采取保守治疗,后死于肿瘤复发。肝动脉血栓形成的病死率为57．1％(4／7)。结论预防肝动脉血栓形成的关键在于提高血管吻合技术。术后常规超声定期检查有助于早期发现和早期治疗。中后期肝动脉血栓形成的后果是引起严重的胆道并发症。

Diagnosis and treatment of hepatic artery thrombosis after liver transplantation

OBJECTIVE: To summarize the experience in prevention, diagnosis, and management of hepatic artery thrombosis (HAT) after orthotopic liver transplantation (OLT). METHODS: The clinical data of 198 patients undergoing OLT from April 1993 to September 2003 were analyzed among which 96 underwent anastomosis of hepatic artery with 7/0 prolene by running suture (group 1) and 102 by intermittent suture (group 2). Ultrasonic examination was routinely performed every day within two weeks after operation and then performed selectively afterwards. RESULTS: The incidence rate of HAT in group 2 was 1.0% (1/102), significantly lower than that in group 1 (6.3%, 6/96) (chi(2) = 4.027, P = 0.045). HAT was discovered by color ultrasonography in 6 of the 7 cases, and by exploratory laparotomy in 1 case. Out of the 7 patients with HAT, 6 received emergency thrombectomy, and 1 received conservative therapy but died from tumor recurrence eventually. Biliary complication developed in 3 out of the 6 cases after thrombectomy of whom 2 died of liver failure and one waited for retransplantation. One of the other 3 cases died of renal failure, and 2 cases survived. The mortality of patients with HAT was 57.1% (4/7). CONCLUSION: The technique of hepatic artery anastomosis is the key factor for the prevention of HAT. Routine ultrasonography is important in early detection of HAT after OLT. Biliary complication is a severe outcome secondary to HAT.