肝移植术后肝动脉血栓形成的溶栓治疗3例报道

目的 探讨肝移植术后肝动脉血栓形成的溶栓治疗价值。方法对50例同种异体肝移植病例，术后以彩色多普勒超声(CDI)定期监测肝动脉血流，怀疑肝动脉血栓形成(HAT)行动脉造影，确诊3例，即刻行介入溶栓治疗，经导管分别在20分钟内予尿激酶12．5万单位、30分钟内予尿激酶25万单位和肝素50mg，及4小时内注入尿激酶60万单位。结果3例溶栓治疗后，肝动脉均再通。1例因二次血栓形成再次溶栓成功。但均发生不同程度的腹腔内出血，1例保守治疗痊愈，1例经开腹手术止血后痊愈，另1例死于多器官功能衰竭。结论对怀疑HAT病例，应尽早行动脉造影。改进后的溶栓疗法有可能成为治疗HAT的可选择方法。

Intra-arterial thrombolytic therapy for hepatic artery thrombosis after liver trAnsplantation

Objective To explore the clinical value of intra-arterial thrombolysis for hepatic artery thrombosis after liver transplantation. Methods Routine color Doppler imaging (CDI) was used to detect the hepatic artery thrombosis (HAT) after liver transplantation in 50 cases. Suspected patients were further confirmed by immediate angiography. Three cases of HAT were treated by intra-arterial thrombolysis: infusion of 125,000U urokinase within 20 minutes, 250,000U urokinase and 50mg heparin within 30 minutes, and 600,000U urokinase within 4 hours, respectively. Results Hepatic artery recanalization was obtained in all 3 cases. A second HAT occurred in 1 case, in which a second intra-arterial thrombolysis was successfully completed. Intra-abdominal hemorrhage, however, was found in all 3 cases: 1 patient was cured by preservative treatment, 1 was cured by hemostatic laparotomy and the rest 1 died of multiple system organ failure after hemostatic operation. Conclusions Angiogrhphy should be used as early as possible in suspected HAT cases. Improved intra-arterial thrombolytic therapy may be a promising method in the treatment of HAT.