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肝移植术后门静脉瘤2例并文献复习

赵洪强, 董草儿, 侯昱丞, 等. 肝移植术后门静脉瘤2例并文献复习[J]. 器官移植, 2023, 14(5): 708-713. doi: 10.3969/j.issn.1674-7445.2023105
引用本文: 赵洪强, 董草儿, 侯昱丞, 等. 肝移植术后门静脉瘤2例并文献复习[J]. 器官移植, 2023, 14(5): 708-713. doi: 10.3969/j.issn.1674-7445.2023105
Zhao Hongqiang, Dong Cao’er, Hou Yucheng, et al. Portal vein aneurysm after liver transplantation: report of two cases and literature review[J]. ORGAN TRANSPLANTATION, 2023, 14(5): 708-713. doi: 10.3969/j.issn.1674-7445.2023105
Citation: Zhao Hongqiang, Dong Cao’er, Hou Yucheng, et al. Portal vein aneurysm after liver transplantation: report of two cases and literature review[J]. ORGAN TRANSPLANTATION, 2023, 14(5): 708-713. doi: 10.3969/j.issn.1674-7445.2023105

肝移植术后门静脉瘤2例并文献复习

doi: 10.3969/j.issn.1674-7445.2023105
基金项目: 国家自然科学基金重点项目(81930119);中国医学科学院医学与健康科技创新工程创新单元(2019-I2M-5-056)
详细信息
    作者简介:
    通讯作者:

    汤睿(ORCID:0000-0003-3118-3842),博士,副主任医师,研究方向为肝移植的临床与基础研究,Email:tangrui_hs@163.com

  • 中图分类号: R617, R543

Portal vein aneurysm after liver transplantation: report of two cases and literature review

More Information
  • 摘要:   目的  总结肝移植术后门静脉瘤的诊疗经验。  方法  回顾性分析2例肝移植术后门静脉瘤患者的临床资料,结合文献复习总结其临床特点、诊断、治疗及预后。  结果  两例肝移植术后门静脉瘤均为肝内型,同时合并门静脉血栓、门静脉高压表现。例1患者给予针对性内科保守治疗,患者拒绝行再次肝移植手术,出院后病情加重,最终因移植肝衰竭、肾衰竭、肺部感染、感染性休克死亡。例2患者给予大剂量糖皮质激素冲击治疗,患者肝功能无改善,接受二次肝移植后恢复顺利。  结论  肝移植术后远期合并门静脉瘤(尤其是肝内型)可能预示预后不良,需正确认识、密切随访、积极处理,适时考虑再次肝移植是可供选择的治疗方案。

     

  • 图  1  例1患者肝移植术后PVA的影像学表现

    注:A图为CT平扫水平位显示门静脉左右支瘤样扩张,最大直径为40.7 mm,并可见TIPS支架影(箭头所示);B图为CT平扫冠状位显示肝内门静脉左右支瘤样扩张,并可见TIPS支架影(箭头所示);C图为超声多普勒显示肝内形状不规则的无回声病变与门静脉系统相连。瘤内可见血流充盈缺损,另可见强回声影,为TIPS支架(箭头所示);D图为超声多普勒显示该病变内部为源自静脉系统的湍流血流信号,诊断为肝内门静脉左右支静脉瘤。瘤内血流充盈缺损未见血流信号,诊断为门静脉血栓。

    Figure  1.  Imaging findings of PVA after liver transplantation in case 1

    图  2  例2患者肝移植术后PVA的影像学表现

    注:A图为CT平扫水平位显示门静脉左右支瘤样扩张,最大直径34 mm;B图为CT平扫冠状位显示肝内门静脉左右支瘤样扩张,并可见门静脉支架影(黑色箭头所示);C图为超声多普勒显示该肝内形状不规则的无回声病变与门静脉系统相连,其内可见源自静脉系统湍流血流信号,诊断为肝内门静脉左右支静脉瘤;D图为二次肝移植术中见门静脉左右支呈瘤样扩张,肝门区门静脉吻合口狭窄,肝脏淤血肿胀。

    Figure  2.  Imaging findings of PVA after liver transplantation in case 2

    表  1  文献报道的5例肝移植术后PVA患者临床资料

    Table  1.   Clinical data of 5 patients with PVA after liver transplantation reported in literature

    研究者年份受者年龄原发病手术方式门静脉吻合
    特点
    发现PVA时间
    及方式
    报道时PVA
    直径
    PVA
    位置
    疾病转归
    Ferraz-Neto BH, et al[3]2004年59岁丙型病毒性肝炎肝硬化经典原位
    肝移植
    供受者不匹配,门静脉整形式吻合术后3年常规超声复查发现5.7 cm×
    5.7 cm×
    5.2 cm
    肝内术后6年,疾病进展,患者因移植肝衰竭死亡
    Francesco FD, et al[4]2010年60岁丙型病毒性肝炎肝硬化经典原位
    肝移植
    供受者端端吻合术后10年因肠梗阻、结肠肿瘤入院时CT检查发现最大直径
    6.3 cm
    肝外随访至术后17年,无PVA相关症状及并发症
    Quan JR,
    et al[5]
    2012年46岁乙型病毒性肝炎肝硬化经典原位
    肝移植
    供受者端端吻合术后7年常规超声复查发现肝外随访至术后10年,无PVA相关症状及并发症
    Molinares B,
    et al[6]
    2013年6岁急性甲型病毒性肝炎减体积
    肝移植
    供受者端端吻合术后2年常规超声复查时发现14 mm×
    18 mm
    肝外随访至术后4年无PVA相关症状及并发症
    Nassafi EM,
    et al[7]
    2022年25岁糖原贮积病Ⅳ型背驮式
    肝移植
    术后4年超声复查发现最大直径
    35 mm
    肝内术后19年,发现胆肠吻合口狭窄并肝内胆管扩张,可能与PVA相关。经胆道扩张治疗后,病情好转
      注:①-为文献未提及。
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出版历程
  • 收稿日期:  2023-05-22
  • 网络出版日期:  2023-07-20
  • 刊出日期:  2023-09-15

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