术前门静脉血栓对终末期肝硬化患者行肝移植手术的影响

目的  探讨术前门静脉血栓对终末期肝硬化患者行肝移植的影响。方法  回顾性分析2007年1月至2011年12月在中山大学附属第三医院器官移植中心接受肝移植手术的182例终末期肝硬化患者的临床资料。将合并门静脉血栓的13例(Yerdel分级Ⅰ级3例, Ⅱ级6例, Ⅲ级2例, Ⅳ级2例)患者作为门静脉血栓组, 其余169例无门静脉血栓的患者作为对照组。比较两组患者肝移植术中和术后情况。结果  与对照组比较, 门静脉血栓组的手术时间和术中出血量较多(均为P < 0.05), Ⅲ~Ⅳ级血栓者的手术时间和术中出血量亦较多(均为P < 0.05)。术后1个月, 门静脉血栓组发生门静脉血栓1例(8%), 对照组发生3例(2%), 两组比较差异有统计学意义(P < 0.05)。门静脉血栓组术后3年存活率为46%(6/13), 对照组相应为84%(142/169), 两组比较差异有统计学意义(P < 0.05)。结论  Ⅲ~Ⅳ级门静脉血栓会明显增加肝移植手术难度和风险, 但只要术前严格评估门静脉血栓情况, 术中采用合理的门静脉重建方式, 依然可以取得良好的疗效。

Effect of preoperative portal venous thrombosis on liver transplantation for patients with end-stage liver cirrhosis

Objective To investigate the effect of preoperative portal venous thrombosis on liver transplantation for patients with end-stage liver cirrhosis. Methods Clinical data of 182 patients with end-stage liver cirrhosis undergoing liver transplantation at the Organ Transplantation Center of the Third Affiliated Hospital, Sun Yat-sen University from January 2007 to December 2011 were retrospectively studied. Thirteen patients complicated with portal venous thrombosis (3 patients were in Yerdel gradeⅠ, 6 were in grade Ⅱ, 2 were in grade Ⅲ and 2 were in grade Ⅳ) were divided into the portal venous thrombosis group. Other 169 patients without portal venous thrombosis were divided into the control group. The intra-operative and postoperative conditions of patients were compared between two groups. Results Compared with the control group, there were longer operation time, more intra-operative blood loss in the portal venous thrombosis group and the patient with Yerdel grade Ⅲ-Ⅳ. There was significant difference (both in P < 0.05). At one month after transplantation, one patient (8%) in the portal venous thrombosis group and three patients (2%) in the control group developed portal venous thrombosis, and there was significant difference (P < 0.05). Three-year survival rate of the portal venous thrombosis group was 46% (6/13) and that of the control group was 84% (142/169), and there was significant difference (P < 0.05). Conclusions Portal venous thrombosis of grade Ⅲ and Ⅳ may significantly increase the difficulty and risks of liver transplantation. However, the good curative effect may also be obtained only when the portal venous thrombosis is strictly assessed, and the rational portal venous reconstruction method is used during the operation.