小儿肝移植术后门静脉狭窄球囊扩张治疗的中长期结果

摘要

Objective To evaluate the medium and long-term therapeutic results of percutaneous transhepatic angioplasty for portal vein stenosis (PSV) following pediatric liver transplantation.Methods From Jan.2008 to Dec.2012,5 cases with PVS after pediatric liver transplantation received percutaneous transhepatic angioplasty.There were 3 male and 2 female cases ranging from 7 months to 8 year-old with the median age of 2 years and 10 months.The protopathy included 1 Carolis disease and 4 congenital biliary atresia.The therapeutic results were monitored by clinical follow-up and imaging examination.The clinical data,imaging examination and therapeutic results were analyzed.Results All interventions were performed successfully,and the treatment efficacy was 100％.One patient was diagnosed with earl-onset PVS at 0.5 month after liver transplantation.Four patients were diagnosed with late-onset PVS at 3-30 months after liver transplantation.The prestenotic portal venous average diameter was (2.3 ± 0.6) mm (1.2-3.0 mm),the degrees of stenosis were 70％-95％.The poststenotic portal venous average diameter was (9 ± 1) mm (8-10 mm) (t =32.560,P ＜ 0.05).The prestenotic portal venous average pressure gradient was (11.0 ± 3.2) mmHg (8-16 mmHg),and the poststenotic portal venous pressure gradient was(2.2 ± 1.5) mmHg(0-4.0 mmHg) (t =8.242,P ＜ 0.05).Postoperative follow-up was 10-66 months,the portal veins of all cases were patent,and patency rate was 100％.Conclusions Percutaneous transhepatic stent angioplasty is an effective and safe method for treatment of PVS following liver transplantation.Its medium and long-term patency rates are high.%目的 探讨小儿肝移植术后门静脉狭窄(PVS)介入治疗的中长期结果及治疗意义.方法 回顾性分析2008年1月至2012年12月肝移植术后PVS 5例患儿资料,男3例,女2例;年龄7个月～8岁,中位年龄2岁10个月.患儿原发病:1例为Carolis病,4例为先天性胆道闭锁.患儿均采用球囊扩张治疗,对患儿临床资料、影像随访资料、介入治疗的并发症和预后等情况进行总结.结果 5例肝移植术后PVS患儿球囊扩张治疗均成功,成功率为100％.肝移植术后早期狭窄1例,发生于术后0.5个月,迟发性狭窄4例,发生于术后3 ～ 30个月.PVS部位均发生在门静脉吻合口部位,狭窄部位门静脉直径为(2.3 ±0.6) mm(1.2～3.0 mm),狭窄程度为70％ ～ 95％.患儿均采用球囊扩张,球囊扩张后狭窄部位的直径为(9±1)mm(8～10 mm)(t=32.560,P＜0.05).扩张前狭窄两端压力梯度为(11.0±3.2)mmHg(8～16 mmHg),扩张后狭窄两端压力梯度为(2.2±1.5) mmHg(0 ～ 4.0 mmHg)(t=8.242,P＜0.05).术后随访10～ 66个月,患儿门静脉均通畅,通畅率为100％.结论 肝移植术后PVS的介入治疗是一种安全、有效的治疗方法,中长期随访结果通畅率高.