摘要
目的评价用介入技术治疗原位肝移植(OLT)后早期肝动脉血栓形成(HAT)的安全性和疗效。方法对9例OLT后早期HAT患者进行了介入治疗。男性8例、女1例,年龄32～63岁(平均47.6岁),9例均表现为术后转氨酶、胆红素进行性增高。HAT发生于移植术后16h～10d(平均5d),超声波检查提示HAT、为血管造影证实。介入治疗方法有肝动脉内留置导管持续低剂量溶栓和肝动脉内支架置入术,同时经静脉给予低剂量肝素。肝动脉内溶栓期间间隔12h复查超声波。结果溶栓治疗成功7例,占78%(7/9),复查血管造影显示肝固有动脉有血流通过,肝内动脉分支显影,肝功能明显改善,肝动脉内留置导管时间为12h～9d(平均4.8d)。7例溶栓成功的患者均有不同程度的肝固有动脉吻合口处狭窄,其中6例狭窄程度>90%、进行了肝动脉狭窄区血管内支架置入术。溶栓治疗失败2例。1例于溶栓开始后12h发生腹腔内出血,做急诊开腹探察、发现肝动脉吻合口出血,随即做再次吻合。1例留置导管溶栓7d后未能开通肝动脉阻塞,但向肝脏供血的侧枝建立、肝功能有所改善,未做进一步治疗。7例治疗成功者术后随访2～14个月(中位值6个月),一般情况良好,复查超声波显示肝动脉血流通畅。结论经导管血管内介入技术是治疗OLT后早期HAT的有效方法,有较高的安全性。
Objective To evaluate the safety and efficacy of interventional radiological techniques in management of early hepatic artery thrombosis （ HAT ） after orthotopic liver transplantation （ OLT ）. Methods Nine patients with HAT after OLT, 8 males and 1 female, aged 47.6 （ 32 - 63 ） , presenting elevation of liver enzymes and bilirubin, whose diagnosis was suggested by Doppler uhrasonography and confirmed by angiography 16 hours to 10 days after the OLT, underwent interventional radiological techniques, including indwelling transcatheter hepatic artery （HA） thrombolysis with a low dose of urokinase, and stent placement into the stenotic segment of HA. Contemporaneous syst4emic low dose of heparin was given intravenously. Uhrasonography was performed every 12 hours during the intra-arterial （IA） thrombolysis. Results HA flow was established in 7 of the 9 patients （78%） 12 hours to 9 days （ on average 4.8 days ） after the IA thrombolysis with significant improvement of liver functions. HA stenosis （HAS） at the anastomotic stoma was found in 6 of these 7 patients, and stent placement at the stenotic segment was performed successfully in 6 of them with a degree of stenosis over 90%. IA thrombolysis failed in 2 cases. One patient with intraperitoneal hemorrhage 12 hours after the treatment underwent emergent graft revision and the bleeding place was found at the HA anastomotic stoma. One patient remained completely occluded of the HA 7 days after the treatment; however, the collateral flow to the liver was identified. His liver function was improved without further intervention. Follow-up of 6 months （2 - 14 months） showed that the 7 patients with successful HA recanalization had a good clinical course with normal graft function. Conclusion Transcatheter endovascular interventional techniques are effective on treatment of early HAT after OLT.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2005年第39期2767-2771,共5页
National Medical Journal of China
关键词
肝移植
肝动脉
血栓形成
放射学
介入性
Liver transplantation
Hepatic artery
Thrombosis
Radiology,interventional
