肝移植术中门静脉血栓和瘤栓的处理

目的 探讨肝移植时门静脉血栓和瘤栓的处理方法和临床效果.方法 2000年8月至2004年底我院施行的150例肝移植患者中5例为肝硬化伴门静脉血栓形成,21例为肝癌伴门静脉瘤栓及/或血栓形成,共26例.这些病例在术中清除了门静脉内的栓子,3例又行门静脉壁部分切除及低位门静脉对端吻合术,1例行门腔静脉半转位吻合术.结果 26例中1例术后门静脉又再发血栓形成.21例肝癌合并门静脉瘤栓者,术后近期死亡3例,分别死于：门静脉继发性血栓形成,移植肝原发性无功能和多器官衰竭.18例得到长期随访,术后1、2、3年生存率分别为：66.7%,38.9%,27.8%.结论 肝移植时受体门静脉合并血栓/瘤栓者在清除栓子后再行肝移植仍然可取得较好的疗效.

Management of cirrhotic portal vein thrombosis and portal vein tumor thrombi in patients undergoing liver transplantation

Objective To evaluate the effect of intraportal vein embolectomy on clinical outcome of patients receiving liver transplantation. Methods From Aug 2000 to Dec 2004 we performed liver transplantation for 26 cases with intra portal vein embolus among them 5 patients were with cirrhotic portal vein thrombosis, and 21 hepatocellular carcinoma (HCC) cases with portal vein tumor thrombi (PVTT). Thrombectomy and/or embolectomy was performed in all the 26 patients, among which organized thrombi were resected along with partial removement of the portal veinous wall in 3 patients. Low position end-to-end portal vein anastomosis was completed in 25 cases. Cavoportal hemitransposition was performed in 1 patient. Result Postoperative portal vein patency was identified in 25 cases, de novo intraportal vein thrombosis was found in one case. Three patients died perioperatively of portal vein rethrombosis, primary nonfunction of the liver, and MOF respectively. Eighteen patients were followed up from 6 to 45 months with 1-, 2-, and 3 year survival rate of 66. 7%, 38.9% and 27.8%, respectively. Conclusion Intraportal vein thrombosis and/ or tumor thrombi is not itself a contraindication for liver transplantation provided that proper embolectomy is performed to allow a satisfactory portal vein reconstruction. The long term survival of the recipient is satisfactory.