肝动脉溶栓联合脾动脉栓塞术治疗肝移植术后肝动脉血栓的临床分析

目的  分析经导管肝动脉溶栓联合脾动脉栓塞术在肝移植术后肝动脉血栓（HAT）治疗中的临床疗效。方法  回顾性分析因肝移植术后HAT行经导管肝动脉溶栓联合脾动脉栓塞术的9例患者的临床资料。总结HAT的发生情况和溶栓治疗情况；总结溶栓相关并发症的发生情况和预后情况；分析典型病例的溶栓治疗过程。结果  HAT发现时间为肝移植术后1~66 d，中位时间10 d。HAT形成部位分别为肝动脉主干吻合口处8例，右支1例。9例均为发现当日急诊行经导管肝动脉溶栓联合脾动脉栓塞术。肝动脉术中开通4例，术后留置导管溶栓开通3例，开通时间为72~96 h，总开通率为7/9。术后溶栓相关并发症为腹腔出血1例。死亡3例，死因分别为肝动脉开通失败后死于肝衰竭和感染2例，介入治疗后70 d死于胆道缺血及全身感染1例。结论  肝动脉溶栓联合脾动脉栓塞术对于肝移植术后HAT的治疗具有良好的临床疗效，可作为无条件再次肝移植情况下的首选治疗方案。

Clinical analysis of hepatic arterial thrombolysis combined with splenic arterial embolization in treatment of hepatic arterial thrombosis after liver transplantation

Objective To analyze the clinical efficacy of transcatheter hepatic arterial thrombolysis combined with splenic arterial embolization in the treatment of hepatic artery thrombosis (HAT) after liver transplantation. Methods Clinical data of 9 patients diagnosed with HAT after liver transplantation undergoing transcatheter hepatic arterial thrombolysis combined with splenic arterial embolization were retrospectively analyzed. The incidence of HAT and clinical efficacy of thrombolytic therapy were summarized. The incidence of thrombolysis related complications and clinical prognosis were evaluated. The thrombolytic therapy procedures of typical cases were analyzed. Results HAT was diagnosed at 1-66 d after liver transplantation with a median time of 10 d. The formation site of HAT was found at the anastomosis of the main hepatic artery in 8 cases and at the right branch in 1 case. Upon diagnosis, 9 patients received transcatheter hepatic arterial thrombolysis combined with splenic arterial embolization in emergency. The hepatic artery was open during operation in 4 cases and treated with postoperative thrombolytic therapy with indwelling catheter in 3 cases. The opening time for inwelling catheter was 72-96 h. The total successful rate was 7/9. The thrombolysis related complication of abdominal hemorrhage occurred in 1 case after surgery. Three cases died, including 2 cases of liver failure and infection, and 1 case of biliary ischemia and systemic infection at 70 d after interventional therapy. Conclusions Hepatic arterial thrombolysis combined with splenic arterial embolization is an efficacious treatment for HAT after liver transplantation, which can serve as the optimal therapy for patients who are unable to undergo secondary liver transplantation.