肝移植术后并发症与介入治疗一、肝动脉血栓形成

肝移植术(LT)后并发症的有效处理很大程度上决定手术的成败。LT后肝动脉血栓形成(HAT)可直接导致移植肝坏死、胆汁瘤与肝功能衰竭。及早发现并明确诊断对预后至关重要,多普勒超声可作为首选的普查方式,CTA、MRA及血管造影可以进一步明确诊断。肝动脉血栓形成后局部溶栓简便易行,与球囊扩张、支架置入技术联合应用通常取得较好的疗效,同时需寻求规范化诊疗方案;血管重建术与加压舱治疗也是有效方法,不得已时,肝脏再移植仍是重要的最后治疗措施。     

介入治疗肝移植术后复杂肝动脉并发症一例

患者 ,男 ,47岁 ,因肝硬化肝癌行肝移植术。术前血清丙氨酸转移酶 (ａｌａｎｉｎｅｔｒａｎｓｆｅｒａｓｅ ,ＡＬＴ) 80Ｕ/ｌ,总胆红素 (ｔｏｔａｌｂｉｌｉｒｕｂｉｎ ,Ｔ Ｂｉｌ) 8μｍｏｌ/ｌ。术中顺利 ,术后肝功能仅轻度异常 (ＡＬＴ 2 5Ｕ/ｌ ,Ｔ Ｂｉｌ 5 6μｍｏｌ/ｌ)。 2周后肝功能恶化 ,ＡＬＴ 40Ｕ/ｌ,Ｔ Ｂｉｌ 2 2 4μｍｏｌ/ｌ。Ｂ超检查肝动脉血流显示不清 ,胆道及门静脉结构正常。肝动脉造影 :肝固有动脉吻合口段狭窄约 80 % ,吻合口近端形成约 8ｍｍ直径的假性动脉瘤 ,可见血流喷射状向内流入。肝左动脉狭窄 5 0 % ,肝总…     

超声显像与肝移植后肝动脉血栓形成

随着各项技术的开展，肝移植手术成功率与患者生存率越来越高，术后护理水平的提高，包括对其并发症做出快捷的诊断，是生存率提高的一个重要原因。超声诊断技术的提高，特别是彩色多普勒技术的应用，给临床医生对患者病情的评估提供了新的手段。在众多的并发症中，肝动脉血栓形成（HAT）较为常见，并且具有相当的危险性。因此，如何方便快捷地作出诊断，是摆在临床医师和影像医师面前的一个重要课题。本文就近年来超声在肝移植后HAT中的应用作一系统回顾。1概况在肝移植后众多并发症中，HAT后果较为严重，仅次于门静脉血栓形成卜。据报…     

肝移植术后并发症与介入治疗二、肝动脉狭窄

移植术后肝动脉狭窄(HAS)可直接导致移植肝功能丧失与胆管并发症。及早发现并明确诊断对预后至关重要,多普勒超声可作为首选的筛查方式,血管造影可以进一步明确诊断。肝动脉狭窄后球囊扩张术仍是有效的方法,如有条件采用冠脉支架对HAS更为合适,尤其是肝动脉扭曲者。但对治疗无效的HAS外科血管再通或再次移植仍是挽救措施。     

肝移植术后肝动脉狭窄行介入治疗的护理

目的 探讨肝移植术后肝动脉狭窄介入治疗的围手术期护理措施,为减少相关并发症、改善患者预后提供参考.方法 结合患者情况及介入治疗的特殊性,以移植病房20例肝移植术后肝动脉狭窄行介入治疗的患者为样本,从术前准备、术后护理及出院指导3方面对患者进行护理.结果 20例介入治疗患者均无出血倾向及急性血栓形成,症状明显好转.结论 介入治疗对于肝移植术后肝动脉狭窄是一种有效的治疗方法.加强介入治疗后的护理可有效预防与手术相关的并发症的发生、巩同治疗效果.     

杂交技术治疗肝移植术后肝动脉血栓形成1例

该文报道了因乙型病毒性肝炎肝硬化失代偿行同种异体经典原位肝移植手术、术后肝动脉血栓形成1例。该病例全麻下行剖腹探查术,于吻合口处纵向切开血管取出血栓,阻断受体端血管,尿激酶及肝素盐水反复冲洗吻合口远端供肝肝动脉,并给予抗凝、解除痉挛等治疗。术后肝动脉造影见腹腔干、脾动脉显影较快,肝总动脉显影较慢,肝总动脉造影见肝固有动脉起始部狭窄,全程严重扭曲,肝左、肝右动脉远端未显影,分析为肝内动脉微血栓形成,遂将溶栓导管置于胃十二指肠动脉近端,自溶栓导管注入尿激酶后固定各鞘管,行规范溶栓治疗。目前随访15个月,患者转氨酶及胆红素水平均在正常范围,无二次移植的指征。提示,切开取栓联合置管溶栓的杂交手术方式治疗肝移植术后急性肝动脉血栓形成近期与远期疗效良好,可作为肝移植术后急性肝动脉血栓形成的治疗方案之一。     

肝移植术后并发症与介入治疗三、肝移植术后动脉窃血综合征

动脉窃血综合征(ASS)是肝移植术后相对少见的并发症,以脾动脉、胃左动脉、胃十二指肠动脉窃血导致移植肝灌注不足为特征,可导致胆道狭窄甚至移植物失功能等并发症.加强对ASS的认识,获得早期诊断和治疗对移植肝脏功能的保护相当重要.术后常规动态彩色多普勒血流显像(CDFl)检查可筛选可疑病例,血管造影是诊断ASS的金标准.介入性脾动脉栓塞治疗微创、高效、并发症少,而脾动脉中段弹簧圈栓塞是最佳方案.     

11例肝移植术后肝动脉血栓形成的观察与护理

肝动脉血栓(Hepatic artery thrombosis,HAT)形成是肝移植术后最常见的血管并发症,也是导致术后移植物功能丧失和患者死亡的主要原因之一[1],发生率为3%~9%。HAT一旦发生,绝大多数情况下终将导致移植肝脏功能丧失,被迫接受再次肝移植。2002年4月~2006年6月,我院694例同种异体原     

介入治疗肝移植术后肝动脉并发症的初步经验

目的总结采用介入方法治疗肝移植术后并发肝动脉狭窄及血栓形成的初步经验。方法对4例肝移植术后并发肝动脉狭窄或血栓形成的患者行球囊扩张、经动脉溶栓、内支架置入术。结果1例肝动脉狭窄的患者经球囊扩张后临床症状缓解;3例肝动脉血栓形成患者经动脉溶栓后即刻肝动脉血流得到恢复;1例患者溶栓后3d发生吻合口出血,置入带膜支架,症状缓解,1d后肝动脉再次闭塞,2周后行第2次肝移植。结论采用介入方法对肝移植术后并发肝动脉狭窄或血栓形成的患者进行治疗是可行的,但必须谨慎实施,以避免发生出血等并发症。     

肝移植术后肝动脉狭窄的介入治疗

目的 对介入方法治疗肝移植术后肝动脉狭窄的价值进行初步的探索。方法 1998年9月至2001年11月进行的200例肝移植病人中术后18例发生肝动脉狭窄、闭塞，对18例病人行球囊扩张与内支架置入术的资料进行回顾和总结。结果 15例病人成功进行了介入治疗，其中单纯球囊扩张治疗13例，内支架治疗2例，3例病人介入治疗失败。治疗成功的15例病人中7例愈后良好，8例愈后不良。结论 介入方法治疗肝移植术后肝动脉狭窄具有微创、安全、有效的优点，可作为治疗移植术后肝动脉狭窄的首选治疗手段。但早期诊断、早期治疗是影响治疗愈后的重要因素。     

Role of contrast-enhanced ultrasound in decision support for diagnosis and treatment of hepatic artery thrombosis after liver transplantation

Objective

To assess role of contrast-enhanced ultrasound (CEUS) in decision support for diagnosis and treatment of hepatic artery thrombosis (HAT) after liver transplantation.

Materials and methods

Between January 2005 and January 2011, 605 patients underwent liver transplantation in our medical center. All the liver transplant recipients received Doppler ultrasound scanning and CEUS examination was performed in 45 patients with suspected HAT on Doppler ultrasound. Sensitivity, specificity, accuracy, positive predict value and negative predictive value of CEUS in diagnosing HAT were determined based on the results from angiography, surgery and clinical follow-up.

Results

Fourteen HATs, including one late HAT, were diagnosed by CEUS. Twelve HAT cases were confirmed by angiographic and/or surgical findings, while the late HAT and other 31 patients with negative CEUS finding were confirmed by the clinical follow-up. There was a false positive HAT diagnosed by CEUS in which angiography revealed a patent hepatic artery. The sensitivity, specificity, accuracy, positive predict value and negative predictive value of CEUS in diagnosing HAT were 100%, 96.9%, 97.8%, 92.9% and 100%, respectively. In our series of 605 liver transplants, the incidence and mortality of HAT was 2.2% (13/605) and 53.8% (7/13), respectively.

Conclusions

Our study demonstrates the important role of CEUS in decision support for diagnosis and treatment of HAT after liver transplantation. When HAT is suspected by Doppler ultrasound, CEUS shall immediately be performed to elucidate its nature. A negative CEUS finding shall avoid invasive angiography. Such as, CEUS may alter the clinical workflow on HAT detection after liver transplantation.     

肝移植术后肝动脉假性动脉瘤的介入治疗

目的探讨介入技术对肝移植术后假性动脉瘤的治疗价值。 方法收集5例行介入治疗的肝移植术后肝动脉瘤患者,对患者的临床资料、影像学随访资料、介入治疗并发症、预后等情况进行观察和回顾。 结果5例肝动脉假性动脉瘤中发生于肝内肝动脉2例,肝外肝动脉主干3例。3例行介入栓塞治疗,2例行覆膜支架治疗。介入治疗全部取得成功,无相关并发症发生。 结论血管内介入技术是治疗肝移植术后肝动脉假性动脉瘤安全有效的方法。     

球囊扩张式冠脉支架治疗原位肝移植后肝动脉狭窄

目的探讨与分析球囊扩张式冠脉支架在治疗原位肝移植术后肝动脉狭窄中的作用和意义。方法回顾性分析我院2004年6月到2006年9月11例肝移植术后肝动脉狭窄患者的血管内支架治疗资料。结果11例患者共使用13枚球囊扩张式冠脉支架治疗,其中1例由于病变长度,需要2枚支架;1例出现再狭窄需要第2次支架植入。所有病例支架植入技术成功率为100%,随访中未出现与支架术相关的并发症。结论球囊扩张式冠脉支架在肝移植后肝动脉狭窄的治疗中应用安全有效,有极好的技术成功率和中期通畅率。     

Management of hepatic artery steno-occlusive complications after liver transplantation

Steno-occlusive disease (arterial obstructive disease) of the transplant hepatic artery is a collective term that can be used to include hepatic artery thrombosis, hepatic artery stenosis, and hepatic arterial kinks. The latter 2 can be referred to collectively as arterial anatomical defects. This chapter details the angiographic techniques and definitions required to make an accurate angiographic diagnosis of these arterial transplant complications. In addition, the chapter focuses on detailed technical aspects of the endoluminal management of these arterial complications. The chapter discusses the role and technical results of endoluminal management of these arterial complications and, when possible, the lesion morphologies most amenable to endoluminal management.     

The use of coronary stent in hepatic artery stenosis after orthotopic liver transplantation

PURPOSE: This retrospective study was undertaken to evaluate the effectiveness of coronary stent placement in hepatic artery stenosis after orthotopic liver transplantation (OLT). MATERIALS AND METHODS: Of 430 consecutive adult orthotopic liver transplant recipients between November 2003 and September 2005, 17 had hepatic artery stenosis (HAS). Fourteen of them underwent coronary stent placement in the HAS. The technical results, complications, hepatic artery patency and clinical outcome were reviewed. RESULTS: Technical and immediate success was 100%. After a mean follow-up of 159.4 days (range, 9-375 days), all patients obtained patent hepatic arteries except 2 patients occurred hepatic artery restenoses at 26 and 45 days after stent placement, respectively. Kaplan-Meier curve of patency showed cumulated stent patency at 3, 6, and 12 months of 78%, 58% and 45%, respectively. During the follow-up, 8 patients survived, 5 died of septic multiple-organ failure, 1 received retransplantation because of refractory biliary infection. Hepatic artery dissection induced by a guiding catheter occurred in one patient and was successfully treated with a coronary stent. CONCLUSION: Hepatic artery stenosis after OLT can be successfully treated with coronary stent placement with low complication rate and an acceptable 1-year hepatic artery patency rate.     

肝移植术后肝动脉早期血栓形成的介入放射学处理

目的总结肝移植术后早期肝动脉血栓形成的介入处理经验。方法我院502例肝移植术后临床上疑有肝动脉并发症的32例患者行肝动脉造影检查,证实肝动脉主干内血栓形成(HAT)20例。对该20例患者采用经肝动脉内导管持续性尿激酶溶柃治疗及PTA和内支架植入术。结果本组HAT发生率为3.98%(20/502),发生存术后2～19d,中位时间为4.5d,20例血栓形成部位均化于肝动脉吻合口处,其中5例溶栓过程中使用球囊扩张,3例使用支架,2例出现吻合口出血而使用弹簧圈作栓塞和带膜内支架。20例均经介入溶栓治疗后获肝动脉再通。溶栓疗程2～11d,平均2.5d。结论经肝动脉内尿激酶持续性溶栓及PTA和内支架治疗效果良好,可作为肝移植术后HAT的重要治疗手段。     

支架置入治疗肝移植术后肝动脉狭窄的初步临床观察

目的 探讨支架置入治疗肝移植术后肝动脉狭窄（HAS）的可行性及临床效果。方法 回顾性分析13例肝移植术后经肝动脉造影证实、并行肝动脉支架置入（12例）或经皮腔内血管成形术（PTA）治疗（1例）的HAS患者的临床资料及支架置入技术要点。结果 13例患者中，11例成功置入支架，1例PTA加支架置入失败，1例单纯PTA治疗成功。支架术后随访9—227d，平均97d，无一例术后发生支架内再狭窄。诊疗时距在2周内的7例患者，1例支架置入术后9d死于多器官功能衰竭，6例术后血清转氨酶和（或）胆红素恢复正常；而诊疗时距大于2周的4例患者，1例死于胆道感染引起的败血症和肝功能衰竭，3例血清胆红素仍高于正常、反复出现胆道感染，经抗感染和（或）胆道引流病情好转。结论 支架治疗肝移植术后HAS是可行的，指引导管或长鞘技术和冠状动脉支架的应用可提高支架置入技术的成功率。早期诊断、早期治疗是影响支架置入疗效的关键因素。     

Interventional radiology in the management of complications after liver transplantation

The arrival of new surgical transplantation techniques, such as split living donor or auxiliary liver transplantation, have increased the incidence of vascular and biliary complications. The causes, symptoms, and diagnostic modalities of arterial, portal caval, and biliary complications are detailed. Interventional techniques, such as balloon angioplasty and stent placement in the arterial and portal tree, as well as biliary interventional techniques, are discussed.