活体肝移植术后早期肝动脉血栓形成的诊断与治疗

目的探讨活体肝移植术后早期肝动脉血栓形成的诊断与治疗。方法2006年9月至2009年8月天津市第一中心医院单一外科组共实施110例活体肝移植,移植术后7d内每日用彩色多普勒超声(彩超)监测肝动脉血流,怀疑肝动脉血栓形成行肝动脉造影或腹部CT检查,确诊者予介入治疗或手术治疗。结果该组3例术后5～6d发生肝动脉血栓,肝动脉血栓发生率2.7%(3/110)。其中1例再次手术行肝动脉取栓,术后血流正常;2例行介入治疗,放置支架,术后1例再次血栓形成,1例血流流速偏低,2例均发生胆道并发症,但肝功能正常。3例均存活。结论术后早期用彩超监测对肝动脉血栓的诊断至关重要,及时手术取栓或介入放置支架效果良好。

Diagnosis and treatment of early-stage hepatic artery thrombosis after living donor liver transplan-tation

Objective To evaluate the diagnosis and treatment of early-stage hepatic artery thrombosis after living donor liver transplantation （LDLT）.Methods One hundred and ten consecutive patients underwent living donor liver transplantation from September 2006 to August 2009 by the same surgery team in our center （Tianjin First Central Hospital）.Hepatic arterial blood flow was monitored by color Doppler ultrasound screening （DUS） daily during the first week after transplantation.Hepatic artery angiography or abdominal CT examination was performed on recipients with suspected hepatic artery thrombosis （HAT）.The patients with diagnosed HAT were treated with interventional therapy or operation.Results Three patients developed hepatic artery thrombosis after operation in this group on day 5 or day 6 after operation.The incidence of hepatic artery thrombosis in this group was 2.7% （3 /110）.One patient underwent exploratory laparotomy,thrombus dislodgement and hepatic artery re-anastomosis.The blood flow returned to normal post-operation.Interventional therapy was performed in another two cases and stents were placed.One patient had re-thrombosis and the other patient had slow hepatic artery flow.Both of these two patients developed bile duct complications with normal liver function.All patients with HAT survived.Conclusion It is essential to diagnoses HAT by monitoring the artery flow by Doppler ultrasound screening in early period after LDLT.Thrombectomy or stent placements in time are effective treatment for patients with HAT.