肝动脉支架置入术治疗原位肝移植术后肝动脉狭窄的远期疗效

目的 评估肝动脉支架置人治疗肝移植术后肝动脉狭窄的远期疗效.方法 2003年11月至2007年8月间,中山大学附属第三医院共26例确诊为肝移植术后肝动脉狭窄或闭塞患者,其中18例采用了同轴导管技术进行肝动脉支架置入术治疗.对所有患者的临床疗效及肝动脉通畅性进行评估.结果 支架置入术后2个月内有3个患者死亡,1例患者接受再移植.其余14例患者随诊时间均超过2个月.中位随诊时间为21.7个月(2.3～37.2个月).支架术后7例患者肝动脉保持通畅.4例(28.5%)患者出现肝动脉再狭窄.其中2例患者分别于术后5.1和20.5个月接受了再移植治疗.3例患者虽然肝动脉保持通畅,但仍分别死于多器官功能衰竭、肝脓肿和胆道感染.Kaplan-Meier曲线显示1、2和3年患者的生存率分别为76%、76%和76%,移植肝存活率分别为69.5%、69.5%和48.0%,原发性肝动脉通畅率分别为63%、63%和63%.结论 肝移植术后肝动脉狭窄可以采用支架置人成功进行治疗,可以获得令人满意的1、2和3年患者生存率、移植肝存活率和原发性肝动脉通畅率.

Long-term outcomes of hepatic artery stent placement for patients with hepatic artery stenosis after orthotopic liver transplantation

Objective To evaluate the long-term clinical outcomes and complications of coronary stent placement for hepatic artery stenosis (HAS) after orthotopic liver transplantation (OLT) retrospectively. Methods Eighteen of the 26 patients with HAS or hepatic artery thrombosis confirmed by digital subtraction angiography underwent hepatic artery stenting with coaxial catheter technique and then followed up for 21.7 months (2. 3 -37. 2 months). Liver function tests, color Doppler uhrasonography and CT angiography were conducted. Results Three patients died and 1 patient underwent re-transplantation within 2 months after stenting procedure. Seven patients' hepatic arteries looked normal after stenting. Restenosis was seen in 4 patients (28. 5% ). Two of them needed re-transplantation 20. 5 and 5.1 months after stenting respectively. Three patients died of septic multiple-organ failure, liver abscess, and biliary infection respectively though their hepatic arteries were patent. Kaplan-Meier curve showed that the 1-, 2-, and 3-year survival rates were 76% ,76%, and 76% respectively, and the 1-, 2-, and 3-year graft survival rates after stenting were 69. 5%, 69. 5%, and 48. 0% respectively, and the primary hepatic artery patency rates were 63%, 63%, and 63% respectively. Conclusion HAS after OLT can be successfully treated with stent placement with an acceptable 1-, 2- and 3-year patient, graft survival and primary stent patency rates.