肝移植后门静脉供血障碍的诊断和治疗

目的探讨肝移植术后门静脉供血障碍的诊断和治疗方法。方法2002年4月至2005年8月实施肝移植504例，肝移植术后7d内，每天用彩色多普勒血流显像（CDFI）技术检测门静脉血流1次，无异常发现者改为每周1次，1个月后改为每月1次，半年后改为每3个月1次。对于CDFI有异常发现者，予严密监视，并行CT门静脉成像证实。对诊断明确的门静脉狭窄患者早期进行介入治疗。结果504例肝移植中，共发生门静脉供血障碍性并发症12例（2．38%），其中单纯吻合口狭窄9例（1．78％）、吻合口狭窄并局部血栓形成2例（0．40％）、门静脉系统广泛血栓形成1例（0．20％），均经积极治疗后痊愈出院。结论肝移植术后采用CDFI技术的跟踪检查对于早期发现门静脉供血障碍性并发症具有重要意义，CT血管成像具有确诊价值。门静脉狭窄的早期介入治疗是安全、有效的；广泛血栓形成者应尽早行2次肝移植治疗。

Diagnosis and treatment for the insufficient supply to the portal vein after liver transplantation

Objective To explore the methods of diagnosis and treatment for the insufficient supply to the portal vein,to improve the survival rate of patients with liver transplantation.Methods The diagnosis and treatment of the insufficient supply to the portal vein in patients with liver trans- plantation were performed in our hospital from April 2002-May 2005.Results Twelve cases (2.38%)of insufficient supply to the portal vein were found in 504 liver transplantation patients.A- mong them,there were 9 cases of simple stenosis at the anastomosis(1.78%),2 cases of the combi- nation of stenosis and thrombosis at the anastomosis(0.40%),and one case of the intensive forma- tion of thrombosis in the portal vein(0.20%).All the complicated patients recovered and were dis- charged after successful treatment.Conclusions It is of significance for the color Doppler flow image to follow up the patients with liver transplantation in making an early diagnosis of the insufficient sup- ply to the portal vein.CT vascular image is of conforming values.It is safe and effective for the inter- ventionaI therapy in the treatment of portal vein stenosis.The patients with the intensive formation of thrombosis in the portal vein should undergo second liver transplantation.