门静脉血栓形成的外科策略及其对原位肝移植效果的影响

摘要

目的 观察门静脉血栓形成(portal vein thrombosis, PVT)患者原位肝移植(orthotopic liver transplantation, OLT)术中的外科策略,评价外科措施对OLT肝移植效果的影响.方法 我院2002-02至2007-02间836例成人OLT患者中有71例术前合并门静脉血栓(PVT组).回顾性分析所有患者的临床资料,观察PVT组的外科处理策略,评价PVT对肝移植手术风险和治疗效果的影响.结果 71例PVT患者分别接受栓塞段门静脉切除术(18例)、门静脉内血栓切除术(46例)、间置静脉架桥术或曲张静脉吻合术(7例).PVT组手术时间(min)和无肝期时间(min) 明显长于对照组(分别为792.47±162.29和516.18±186.30, P=0.0072;77.53±24.76和48.55±31.20, P=0.033),而两组间术中输血量、平均住ICU时间、住院时间差异无统计学意义(P＞0.05).PVT组术后再栓塞率显著高于对照组 (分别为9.86%和1.44%,P=0.0002).除90 d时PVT组门静脉血流(cm/s)较高(41.43±17.19 和19.85±11.39, P=0.0047)外,两组间各随访时段中移植物功能和PVF没有显著性差异.PVT组围术期病死率略高于对照组,而1、3、5年生存率稍低于对照组,但差异均无统计学意义.结论 术前PVT可能会增加肝移植手术复杂程度,但并不影响肝移植效果.%Objective To study surgical tactics on pre -existing portal vein thrombosis (PVT) in patients undergoing orthotopic liver transplantation (OLT) , and to assess the contributions of those tactics to results of OLT. Methods Between February 2002 and February 2007, a sample of 71 patients with pre -existing PVT (PVT group) out of 836 patients undergoing OLT was studied in terms of surgical tactics. Clinical data were collected to evaluate the impact of PVT on risks of operation and the contributions of surgical strategies to results of OLT. Results The patients received portal veneetomy( 18 cases) , intravenous thrombeetomy(46 cases), venous graft interposition or anastomosis between portal vein and splanehnie varicose vein (7 cases). Albeit longer surgcial procedures [ (792.47 ± 162.29) min vs (516.18 ± 186.30) min, P =0. 0072] and anhepatie phase duration [ (77.53 ±24.76) min vs (48.55 ±31.20) min, P =0. 033 ], there was no difference in blood transfusion requirements, the average ICU stay, as well as hospital stay between the PVT group and the control group. The incidence of postoperative portal rethrombosis was remarkably higher in the PVT group than in the control group ( 9.86％ vs 1.44％, P = 0.0002 ). There was no significant difference in graft function and portal vein flow (PVF) between the two groups except a higher PVF in PVT group on the 90th day (41.43 ± 17.19 vs 19.85 ± 11.39, P = 0. 0047 ). A slightly higher death rate was observed in the perioperative period and a lower 1 -, 3 - , 5 - year survival rate in PVT group, but without significant difference between the two groups. Conclusion OLT in patients with PVT can obtain as desirable outcomes as that in those without PVT in spite of more complicated operative procedures.