Orthotopic liver transplantation in the presence of partial or total portal vein thrombosis: Problems in diagnosis and management
Orthotopic liver transplantation in the presence of partial or total portal vein thrombosis: Problems in diagnosis and management
复制标题
部分或全部门静脉血栓形成的原位肝移植：诊断和治疗问题
DOI：
10.1007/bf01659140
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发表时间：
1993
影响因子：
2.6
通讯作者：
P. Fagniez
中科院分区：
文献类型：
--
作者：
D. Cherqui;C. Duvoux;A. Rahmouni;N. Rotman;D. Dhumeaux;M. Julien;P. Fagniez
自1989年1月至1992年5月，共对69名患者进行了70例原位肝移植（OLT），其中53名患者患有肝硬化（77%）。 11 名患者 (16%) 术前有部分或全部门静脉血栓 (PVT)。其中十名患者患有各种原因的肝硬化。 3 例为完全 PVT，8 例为部分 PVT。所有三例病例均在术前检测到总 PVT。相比之下，8 例患者中只有 3 例在术前诊断出部分 PVT。在其他 5 例部分 PVT 病例中，阻塞是在术中解剖门静脉时发现的。 PVT 的手术治疗包括 10 例静脉血栓切除术，9 例常规门静脉端端吻合术，1 例将移植物门静脉与脾肠系膜汇合处吻合。在 1 例全 PVT 病例中，进行了移植物门静脉与扩张胆总管静脉的非典型吻合。没有出现与术前 PVT 或其处理相关的死亡或并发症。一名患者在术后第 5 天死于原发性移植物无功能。一名患者在 OLT 后 3 个月出现动脉血栓，并成功进行了再次移植。两名患者在 OLT 后 3 个月和 7 个月死于复发性癌症。 8 名患者在 OLT 后 4 至 39 个月内仍存活。我们从这个系列中得出结论：（1）晚期肝硬化移植患者中术前 PVT 的发生率可能很高（本系列中肝硬化患者的 19%）； (2)PVT常为部分性，术前诊断困难； (3) PVT，即使是完全的，也可以在手术期间成功控制，并且似乎不会影响生存。
From January 1989 to May 1992, 70 orthotopic liver transplantations (OLT) were performed in 69 patients, 53 of whom had cirrhosis (77%). Eleven patients (16%) had preoperative partial or total portal vein thrombosis (PVT). Ten of these patients had cirrhosis of various causes. PVT was total in three cases and partial in eight. Total PVT was detected preoperatively in all three cases. By contrast, partial PVT was diagnosed preoperatively in only three of the eight cases. In the five other cases of partial PVT, the obstruction was discovered intraoperatively during dissection of the portal vein. Surgical management of PVT consisted of phlebothrombectomy in ten cases followed by usual end‐to‐end portal anastomosis in nine cases and anastomosis of the graft's portal vein to the splenomesenteric confluence in one case. Atypical anastomosis of the graft's portal vein to a dilated choledocal vein was performed in one case of total PVT. There were no deaths or complications related to the presence of preoperative PVT or to its management. One patient died postoperatively of primary graft nonfunction at day 5. One patient had arterial thrombosis 3 months after OLT and was successfully retransplanted. Two patients died of recurrent carcinoma 3 and 7 months after OLT. Eight patients are alive 4 to 39 months after OLT. We conclude from this series that (1) the prevalence of preoperative PVT among patients transplanted for advanced cirrhosis may be high (19% of the cirrhotics in this series); (2) PVT is often partial and so difficult to diagnose preoperatively; (3) PVT, even when total, can be managed successfully during surgery and does not seem to affect survival.