肝移植术后门静脉狭窄18例临床分析

目的  总结肝移植术后门静脉狭窄的诊治经验。方法  回顾性分析18例肝移植术后门静脉狭窄患者的临床资料，总结门静脉狭窄发生情况、治疗情况及预后。结果  17例患者肝移植术前有肝硬化病史，7例患者肝移植术前有门静脉血栓形成史，8例有脾切除断流或分流等相关手术史；3例为儿童供肝。18例患者门静脉狭窄发生时间为术后23 d~24个月，中位时间为2.2个月，均经彩色多普勒超声（彩超）检查发现，通过门静脉CT血管造影术（CTA）或行介入治疗确诊。所有病例确诊后，均行华法林抗凝治疗；5例有门静脉高压表现的患者行球囊扩张术，其中1例同时放置血管内支架；其余13例采取保守治疗。治疗后9例好转，7例无变化，2例加重。结论  对肝移植术前有肝硬化病史的受者，术后常规彩超监测，CTA或介入治疗确诊门静脉狭窄。无临床症状患者可行保守治疗，合并门静脉高压者可行介入治疗，多数病例预后良好。

Clinical analysis of 18 patients with portal vein stenosis after liver transplantation

Objective To summarize the experience of clinical diagnosis and treatment of portal vein stenosis after liver transplantation. Methods Clinical data of 18 patients presenting with portal vein stenosis after undergoing liver transplantation were retrospectively analyzed. The incidence, treatment and prognosis of portal vein stenosis were summarized. Results Seventeen patients had a medical history of liver cirrhosis before liver transplantation, 7 cases with a medical history of portal vein thrombosis and 8 cases with a medical history of devascularization or shunt with splenectomy. Three cases received the pediatric liver grafts. Eighteen patients suffered from portal vein stenosis from postoperative 23 d to 24 months with a median time of 2.2 months, which was detected by color Doppler ultrasound (CDU) and diagnosed by CT angiography (CTA) of the portal vein or interventional therapy. After the diagnosis was confirmed, all cases received anticoagulant treatment by warfarin. Five patients with portal hypertension underwent balloon dilatation, and one of them received endovascular stent implantation simultaneously. The remaining 13 patients received conservative therapy. After corresponding treatment, 9 cases were mitigated, 7 patients remained unchanged and 2 cases were aggravated. Conclusions For the recipients with a medical history of liver cirrhosis before liver transplantation, portal vein stenosis should be monitored by conventional CDU and diagnosed by CTA or interventional therapy after transplantation. Patients without clinical symptoms can receive conservative treatment. Those complicated with portal hypertension can undergo interventional therapy. Favorable clinical prognosis is obtained in most cases.