肝移植术后迟发性流出道梗阻的诊断和治疗

目的 探讨肝移植术后迟发性流出道梗阻的诊断和治疗方法.方法 2001年6月至2004年11月,共施行肝移植821例次,其中6例患者(背驮式原位肝移植1例,经典原位肝移植4例,减体积肝移植1例)在手术6个月之后出现流出道梗阻,均经彩色超声、计算机断层扫描(CT)检查及下腔静脉造影明确诊断.6例患者均接受经皮腔内血管成形术(PTA),并放置血管内支架治疗,每天口服肠溶阿斯匹林100 mg抗凝治疗半年.治疗期间对患者进行监测和定期随访.结果 肝移植术后迟发性流出道梗阻的发生率为0.73%.6例患者均为肝后下腔静脉及肝静脉狭窄,经PTA并放置血管内支架治疗后,血流恢复通畅,下肢水肿消失,肾功能恢复良好,长期随访无复发.结论 经彩色超声检查怀疑流出道梗阻的患者应行腹部强化CT检查,可以为诊断提供有力的证据;高度怀疑流出道梗阻的患者应进行下腔静脉造影,检测狭窄部位的压力梯度变化.经皮腔内血管成形术并放置血管内支架治疗肝移植术后迟发性流出道梗阻安全可靠,长期疗效满意.

Delayed onset outflow obstruction after liver transplantation-diagnosis and treatment

Objective To study the method for diagnosis and treatment of delayed outflow obstruction after liver transplantation.Methods From June 2001 to Nov.2004,821 patients received liver transplantation in our hospital.Outflow obstruction occurred in 6 patients (one case of reducedsize liver transplantation,one case of piggyback orthotopic liver transplantation and 4 cases of orthotopic liver transplantation) at 6 month after liver transplantation.Outflow obstruction was identified by color duplex ultrasonography and CT,eventually confirmed by angiography.Percutaneous transluminal angioplasty (PTA) and metallic stent replacement were used in the 6 cases.All patients were administered with aspirin (100 mg every day for 6 months and followed up to now.Results The incidence of delayed onset outflow obstruction after liver transplantation was 0.73%,and the stenosis of the intrahepatic inferior vena cava and hepatic vein was found in 6 patients.Percutaneous transluminal angioplasty and metallic stent replacement were performed in the 6 cases,resulting in restoration of normal blood flow,elimination of low limb edema and normal kidney function.No complications occurred during the period of follow-up.Conclusions Delayed outflow obstruction after liver transplantation identified bv color duplex ultrasonography should be be subjected to CT examination.The patients suspected of delayed outflow obstruction should receive inferior vena cava angiography to test the changes in the pressure gradients in the ends of stenosis.Percutaneous transluminal angioplasty and metallic stent replacement are safe and useful for delayed outflow obstruction after liver transplantation,and long-term result is satisfactory.