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劈离式供肝儿童肝移植门静脉并发症的诊断与治疗

曾凯宁, 杨卿, 姚嘉, 等. 劈离式供肝儿童肝移植门静脉并发症的诊断与治疗[J]. 器官移植, 2024, 15(1): 63-69. doi: 10.3969/j.issn.1674-7445.2023241
引用本文: 曾凯宁, 杨卿, 姚嘉, 等. 劈离式供肝儿童肝移植门静脉并发症的诊断与治疗[J]. 器官移植, 2024, 15(1): 63-69. doi: 10.3969/j.issn.1674-7445.2023241
Zeng Kaining, Yang Qing, Yao Jia, et al. Diagnosis and treatment of the portal vein complications for children undergoing spilt liver transplantation[J]. ORGAN TRANSPLANTATION, 2024, 15(1): 63-69. doi: 10.3969/j.issn.1674-7445.2023241
Citation: Zeng Kaining, Yang Qing, Yao Jia, et al. Diagnosis and treatment of the portal vein complications for children undergoing spilt liver transplantation[J]. ORGAN TRANSPLANTATION, 2024, 15(1): 63-69. doi: 10.3969/j.issn.1674-7445.2023241

劈离式供肝儿童肝移植门静脉并发症的诊断与治疗

doi: 10.3969/j.issn.1674-7445.2023241
基金项目: 国家自然科学基金(81972286、82270690);国家重点研发计划(2017YFA0104304);广东省自然科学基金(2019B020236003);广东省科技计划项目(2020B1212060019);广州市科技计划项目(2023A04J1083)
详细信息
    作者简介:
    通讯作者:

    杨扬(ORCID 0000-0003-4981-4745),博士,主任医师,教授,研究方向为肝移植,Email:yysysu@163.com

  • 中图分类号: R617, R575

Diagnosis and treatment of the portal vein complications for children undergoing spilt liver transplantation

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  • 摘要:   目的  探讨劈离式供肝儿童肝移植门静脉并发症的诊断及治疗策略。  方法  回顾性分析接受劈离式肝移植的88例儿童受者的临床资料。术中根据受者门静脉内径、发育情况,利用门静脉左右分支处进行吻合或间置供者髂静脉搭桥吻合,围手术期采用规范化的门静脉血流监测,术后按肝素钠桥接华法林的方案进行抗凝治疗。经增强CT或门静脉造影确诊门静脉狭窄或血栓形成后,予切开取栓、全身抗凝、介入下取栓、球囊扩张和(或)支架置入等处理。  结果  88例受者中共10例患儿确诊门静脉并发症,其中4例门静脉狭窄,确诊时间分别为术后1 d、2个月、8个月、11个月,6例门静脉血栓形成,确诊时间分别为术中、术后2 d、术后3 d(2例)、术后6 d、术后11个月。1例门静脉狭窄者和1例门静脉血栓形成者于围手术期死亡,门静脉并发症相关病死率为2%(2/88)。其余8例患者中,1例行全身抗凝治疗、2例行门静脉切开取栓术、1例行介入下球囊扩张、4例行介入下球囊扩张及支架置入,术后均长期随访,未再出现门静脉相关症状,复查门静脉血流参数正常。  结论  规范化的术中及术后门静脉血流监测有助于早期发现门静脉并发症,及时采取术中门静脉切开取栓,术后介入下球囊扩张、支架置入等手段可有效治疗门静脉并发症,减少门静脉并发症导致的移植物丢失和受者死亡。

     

  • 表  1  发生门静脉并发症的受者的临床资料

    Table  1.   Clinical data of recipients with portal venous complications

    例序 性别 年龄 供者
    血型
    受者
    血型
    移植物类型 GRWR
    (%)
    并发症
    类型
    诊断时间 处理方式 结局 随访时间
    1 4岁2个月 A B 儿童右三叶 5.6 PVS 术后1 d 抗凝治疗 死亡 16 d
    2 7个月 B AB 成人左半肝
    (S2、S3减体积)
    3.8 PVS 术后2个月 抗凝治疗 无并发症生存 64个月
    3 13岁5个月 O O 儿童右三叶 2.2 PVS 术后11个月 门静脉球囊扩张
    (2次)+支架置入
    无并发症生存 61个月
    4 6个月 B O 成人左外叶 3.2 PVS 术后8个月 门静脉球囊扩张
    (2次)
    无并发症生存 57个月
    5 9个月 O AB 成人左外叶 2.5 PVT 术后2 d 二次肝移植 死亡 8 d
    6 4个月 A A 成人左外叶减体积 4.3 PVT 术中 门静脉切开取栓+
    髂静脉间置搭桥
    无并发症生存 17个月
    7 5个月 O A 成人左外叶 3.9 PVT 术后3 d 门静脉切开取栓 无并发症生存 64个月
    8 1岁1个月 O O 成人左外叶减体积 3.3 PVT 术后3 d 门静脉球囊扩张+
    支架置入
    无并发症生存 51个月
    9 8个月 O B 儿童左外叶 2.6 PVT 术后6 d 门静脉球囊扩张+
    支架置入
    无并发症生存 65个月
    10 9个月 B O 儿童左外叶减体积 3.6 PVT 术后11个月 门静脉球囊扩张+
    支架置入
    无并发症生存 14个月
      注:①GRWR为移植物与受者质量比。
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出版历程
  • 收稿日期:  2023-11-10
  • 录用日期:  2023-11-27
  • 网络出版日期:  2023-11-30
  • 刊出日期:  2024-01-11

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