Outcome of percutaneous transhepatic venoplasty for hepatic venous outflow obstruction after living donor liver transplantation
Outcome of percutaneous transhepatic venoplasty for hepatic venous outflow obstruction after living donor liver transplantation
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DOI：
10.1148/radiol.2391050387
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发表时间：
2006-04-01
期刊：
影响因子：
19.7
通讯作者：
Togashi, K
中科院分区：
文献类型：
--
作者：
Kubo, T;Shibata, T;Togashi, K
目的：回顾性评价活体肝移植术后经皮肝静脉成形术治疗肝静脉流出梗阻的疗效。材料和方法：机构人类受试者研究审查委员会批准了介入方案和回顾性研究，不需要知情同意。所有病例在治疗前均获得患者或患者父母的知情同意。在连续26例（男9例，女17例，中位年龄9岁）怀疑LDLT术后肝静脉流出梗阻的患者中，经皮肝静脉造影及测压证实吻合口流出狭窄的20例患者行静脉成形术。采用配对t检验评估静脉成形术前后的压力梯度。随访期间梗阻复发的患者再次行静脉成形术，不带可扩张金属支架。通畅度分析采用Kaplan-Meier分析。结果：最初的球囊静脉成形术在技术上是成功的，所有患者的临床表现都有所改善。压力梯度+/-标准差由14.6 mg Hg +/- 8.6降至2.2 mg Hg +/- 2.4 （P < 0.001）。11例复发性梗阻行球囊静脉成形术治疗；其中一人接受了支架植入和静脉成形术。静脉成形术后3、12和60个月的主要（无事件）通畅率和95%置信区间（CI）分别为0.80 （95% CI: 0.62、0.98）、0.60 （95% CI: 0.38、0.81）和0.60 （95% CI: 0.38、0.81）。通过反复静脉成形术和可扩张金属支架维持初始辅助通畅，60个月时为1.00。结论：经皮肝静脉成形术是治疗LDLT术后肝静脉流出梗阻的有效方法。(c) RSNA， 2006年。
Purpose: To evaluate retrospectively the outcome of percutaneous transhepatic venoplasty of hepatic venous outflow obstruction after living donor liver transplantation (LDLT).Materials and Methods: The institutional Human Subjects Research Review Board approved the interventional protocol and the retrospective study, for which informed consent was not required. Before treatment, informed consent was obtained from the patient or the patient's parents in all cases. Of 26 consecutive patients (nine male, 17 female; median age, 9 years) suspected of having hepatic venous outflow obstruction after LDLT, 20 patients confirmed to have anastomotic outflow stenosis at percutaneous hepatic venography and manometry underwent venoplasty. Pressure gradients before and after venoplasty were evaluated by using a paired t test. Patients in whom obstruction recurred during follow-up were re-treated with venoplasty with our without expandable metallic stents. Patency was analyzed by using Kaplan-Meier analysis.Results: The initial balloon venoplasty was technically successful in all 20 patients, all of whom had improved clinical findings. The pressure gradient +/- standard deviation was reduced from 14.6 mg Hg +/- 8.6 to 2.2 mg Hg +/- 2.4 (P < .001). Eleven patients had recurrent obstruction and were treated with balloon venoplasty; one of them underwent stent placement, as well as venoplasty. The primary (event-free) patency and 95% confidence interval (CI) at 3, 12, and 60 months after venoplasty were 0.80 (95% CI: 0.62, 0.98), 0.60 (95% CI: 0.38, 0.81), and 0.60 (95% CI: 0.38, 0.81), respectively. The primary assisted patency, maintained with repeated venoplasty and expandable metallic stents, was 1.00 at 60 months.Conclusion: Percutaneous venoplasty is an effective treatment for hepatic venous outflow obstruction after LDLT. (c) RSNA, 2006.