肝移植术后并发症介入治疗.docVIP

肝移植术后并发症介入治疗 　［摘 要］ 目的：探讨肝移植术后并发症介入治疗的应用。方法：对终末期肝病及肝癌肝移植术及介入处理相关资料进行回顾性分析，并对5例肝移植术后并发肝动脉狭窄及血栓形成的患者行球囊扩张、溶栓、内支架置入术。结果：2例肝动脉狭窄的患者经球囊扩张后临床症状缓解;其中1例发生吻合口出血,置入带膜支架,症状缓解。3例肝动脉血栓形成患者经溶栓后肝动脉血流得到恢复。结论：介入治疗对肝移植术后并发肝动脉狭窄及血栓形成的患者进行治疗是可行的,但须谨慎实施,以免发生出血等并发症，介入技术对肝移植术后早期并发症的诊断和处理有重要价值。　　［关键词］ 肝移植;狭窄;血栓形成;介入治疗 　　The Preliminary Experience of Interventional Therapy for Hepatic Arterial Complications After Liver Transplantation 　　Abstract： Objective To study the interventional therapy for hepaticarterial complications after liver transplantation. Methods To summarize the preliminary experience of interventional therapy for the patient after liver transplantation who suffered from late hepatopathy andhepatocarcinoma . Five patients with hepatic arterial stenosis (HAS) or hepatic arterial thrombosis( HAT) after liver transplantation were treated by percutaneous transluminal angioplasty(PTA),transarterial thrombolysis and stent graft placement. Results The symptoms of two patients with HAS was relieved by percutaneous transluminal angioplasty even though stent graft was placed in one patient with hepatic arterial anastomosis hemorrhage. Immediate blood flow of hepatic artery was restored in three patients with HAT after treating by transarterial thrombolysis. Conclusion Interventional therapy is an effective modality for hepatic arterial stenosis and thrombosis after liver transplantation but they must be performed cautiously to avoid hemorrhagic complications.It is of great value for the diagnosis and treatment of complications in early stage after liver transplantation. 　　Key words：Liver transplantation;Stenosis;Thrombosis;Interventional therapy 　　肝脏移植是终末期肝病及肝癌治疗的重要手段,具有良好的应用前景。自1963年Starzl实行世界上首例人体肝移植术以来,肝脏移植技术有了相当的发展,肝移植患者的术后生存率逐步提高［1］。介入技术对术后并发症的治疗也极其重要。本文就肝移植术后并发症的介入治疗进行了探讨。 　　1 材料与方法 　　1.1 病例资料 2002年1月至2006年9月对40例终末期肝病及肝癌患者行同种异体肝移植,其中诊断肝硬化合并肝癌7例,其余33例均为肝硬化门脉高压患者。术后行血管造影及介入治疗5例。证实肝动脉主干内血栓形成、闭塞3例,肝动脉狭窄2例。5例患者中男4例,女1例,年龄42岁～57岁，其中肝癌患者2例,肝硬化门脉高压患者3例。肝移植术至介入治疗平均间隔71 d。 　　1.2 临床表现及造影技