肝移植后无症状性肝动脉血栓形成一例

目的 探讨导致移植肝动脉阻塞后无症状的可能原因。方法 通过肝功能监测、彩色多普勒超声、肝动脉造影、肝组织活检以及胆道造影等手段追踪观察肝动脉血栓形成的临床经过，综合分析导致“无症状”的各种可能因素。结果 肝移植术后第4d肝动脉吻合出现血栓形成，至20d肝动脉接近完全阻塞；肝组织学检查见肝内胆汁淤积、肝细胞水样变性、小胆管上皮细胞萎缩以及汇管区纤维化等病理学改变。肝功能检查提示除γ0谷氨本主酶和碱笥磷酸酶升高之外，肝功能恢复顺利。术后71d血管造影显示肝动脉完全阻塞，但有侧枝循环建立和门静脉代偿性扩张。术后患者始终未出现肝动脉阻塞所特有的临床症状。结论 侧枝循环的建立和门静脉的代偿，使移植肝得以存活；术后2周之内经常进行彩色多普勒超声检查对肝动脉血栓形成的早期诊断有帮助。

A case of asymptomatic process of hepatic artery thrombosis in the patients following orthotopic liver transplantation

Objective To investigate the possible causes for asymptomatic process of hepatic artery thrombosis in the patients following orthotopic liver transplantation (OLT). Methods Hepatic functional tests, color Doppler ultrasonic observation, hepatic arteriographic examinations were done during the course of the development of the hepatic arteriothrombosis. All possible factors leading to the asymptomatic process were comprehensively analyzed. Results At the 4th postoperative day, thrombosis started to form along the anastomosis line. At the 21st postoperative day, the artery became completely thromboses. During this course, serial liver biopsy revealed introhepatic cholestasis, hydropic degeneration of hepatocytes, atrophy of the biliary epithelium and fibrosis in the portal area. Serial monitoring of liver function gradually revealed normal with the exception of elevation of r GT and ALP. At the 71st day after OLT, arteriography showed that hepatic artery remained completely occluded, while the collateral circulation and compensatory expansion of the portal vein were established. The patient didn't have any symptoms of arterial thrombosis. Conclusions In this case, it was the collateral circulation and the compensation of the portal vein that made the allograft survive and helped to prevent the patient from retransplantation after hepatic artery thrombosis. Color Doppler ultrasonic examinations within 2 weeks following OLT were helpful to the early diagnosis of hepatic arteriothrombosis.