肝移植中门静脉-内脏曲张静脉吻合在门静脉机化血栓患者的应用.DOCVIP

临床医学论文-肝移植中门静脉-内脏曲张静脉吻合在门静脉机化血栓患者的应用 ????????? 作者：吴凤东　陈新国　臧运金　李朝阳　沈中阳? 【摘要】? 　　目的：探讨门静脉-内脏曲张静脉吻合在门静脉机化血栓患者肝移植中的应用。方法：对门静脉和肠系膜上静脉均完全被机化血栓阻塞的7例患者实施肝移植，其中3例供体门静脉-曲张冠状静脉吻合；2例髂静脉搭桥供体门静脉和脾门旁曲张的静脉吻合；1例采用供体门静脉－胆总管前曲张静脉吻合； 1例供体门静脉—曲张的胃网膜右静脉吻合。结果：7例手术全部成功。1例术后7 d死于多脏器功能衰竭，但是门静脉血流一直通畅。1例术后6个月发现吻合口狭窄，术后9个月采用经皮肝穿刺门静脉支架置入治愈；其余患者分别随访12～22个月，门静脉血流均通畅，无狭窄或血栓形成，肝、肾功能正常。结论：肝移植中对门静脉和肠系膜上静脉均完全被机化血栓阻塞的患者，行供体门静脉－曲张内脏静脉吻合可取得良好疗效。 【关键词】? 肝移植　门静脉　曲张内脏静脉　栓塞 　　Anastomosis between graft portal vein and splanchnic varicose vein in patients with portal vein and superior mesenteric vein thrombosis during liver transplantation? ??? 【ABSTRACT】 Objective：To investigate the management in patients with complete portal vein (PV) and superior mesenteric vein (SMV) thrombosis during liver transplantation (LT). Methods：Seven patients with complete PV and SMV thrombosis undergone LT, The reconstruction of PV were the anastomosis PV to varicose coronary vein in 3 cases, PV to varicose vein near hilus of spleen in 2 case, PV to varicose vein in front of common bile duct in 1 case, PV to varicose right gastro-epiploic vein in 1 case. Results：All patients undergone successful LT. One case died 7 days after the transplantation of multi-organic nonfunction, but the PV was patent. One case was found stenosis at the anastomosis 6 months after LT, and he was cured by percutaneous transhepatic portography and stent placement. Other patients were followed-up12~22 months, the PVs were patent, and had sufficient blood supply, and they have normal liver and kidney functions now. Conclusion ：The anastomosis between graft portal vein and the splanchnic varicose vein may be a applicable choice for the patients with complete PV and SMV thrombosis during LT. ??? 【KEY WORDS】 Liver transplantation·Portal vein thrombosis·Varicose vein ??? 　　肝脏移植中当门静脉和肠系膜上静脉均完全被机化血栓阻塞时，血栓段门静脉切除或取栓后门静脉端吻合不能完成，此时门静脉的重建直接关系手术的成败。术中采用供肝门静脉与受体曲张的内脏静脉吻合重建门静脉，总结报道如下。 ??? 1　资料与方法 ??? 1.1　一般资料　我院2005年1月～2007年1月完成肝脏移植手术476例，共收治此类患者7例，均为男性，26～66岁。术前原发病：乙型