中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (5): 936-939.doi: 10.3969/j.issn.1673-8225.2011.05.043

• 器官移植临床实践 clinical practice of organ transplantation • 上一篇    下一篇

同一机构5年原位肝移植726例术后并发肝动脉血栓形成14例资料回顾

巫林伟，郭志勇，邰  强，何晓顺，鞠卫强，王东平，朱晓峰，马  毅，王国栋，胡安斌   

  1. 中山大学附属第一医院器官移植科，广东省广州市 510080
  • 收稿日期:2010-07-25 修回日期:2010-09-03 出版日期:2011-01-29 发布日期:2011-01-29
  • 通讯作者: 何晓顺，博士，教授，中山大学附属第一医院器官移植科，广东省广州市 510080 gdtrc@163.com
  • 作者简介:巫林伟☆，男，1978年生，福建省龙岩市人，汉族，2009年中山大学毕业，博士，主要从事器官移植方面的研究。 lw97002@163. com

Hepatic artery thrombosis after orthotopic liver transplantation in 14 of 726 cases: A review in the same institute within 5 years

Wu Lin-wei, Guo Zhi-yong, Tai Qiang, He Xiao-shun, Ju Wei-qiang, Wang Dong-ping, Zhu Xiao-feng, Ma Yi, Wang Guo-dong, Hu An-bin   

  1. Department of Organ Transplantation, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou  510080, Guangdong Province, China
  • Received:2010-07-25 Revised:2010-09-03 Online:2011-01-29 Published:2011-01-29
  • Contact: He Xiao-shun, Doctor, Professor, Department of Organ Transplantation, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China gdtrc@163.com
  • About author:Wu Lin-wei☆, Doctor, Department of Organ Transplantation, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China lw97002@163.com

PDF

371

被引次数

7

摘要：

背景：虽然肝移植技术已经成熟，但肝动脉血栓形成仍是造成肝移植后移植物丢失的重要原因之一，肝动脉血栓形成如果不能及早发现处理，只有再次肝移植才能挽救患者生命。
目的：总结原位肝移植后并发肝动脉血栓形成的治疗体会。
方法：中山大学附属第一医院器官移植中心从2004-01/2009-12共实施726例成人尸肝移植，共14例患者经造影证实在肝移植后出现肝动脉血栓形成，回顾性分析以上14例患者的临床资料。
结果与结论：肝动脉血栓形成的发生率为1.9%(14/726)，发生的平均时间为移植后10 d(1~41 d)。14例肝动脉血栓形成患者中，6例表现为急性的肝功能恶化，4例表现为胆漏，1例表现为肝脓肿，3例无明显临床症状。3例行急诊肝动脉再血管化，2例行肝动脉溶栓治疗，3例行肝动脉再血管化联合肝动脉局溶栓治疗，6例行再次肝移植。本组肝动脉血栓形成相关的死亡率为42.9%(6/14)，其中2例行肝动脉再血管化后因胆道坏死、肝功能衰竭死亡；1例溶栓后再次血栓形成并发多器官功能衰竭死亡；1例肝动脉再血管化联合肝动脉溶栓后因肾功能衰竭、严重感染死亡；2例再次移植后早期因严重感染死亡。8例患者康复出院，并常规随访18~66个月，其中2例患者分别于肝移植后18，29个月因肝癌复发死亡，以上患者随访过程中移植肝功能正常，肝动脉畅通。提示肝动脉血栓形成是肝移植后的严重并发症，在造成不可逆的胆道和肝实质损伤前，尽早恢复肝动脉血流可以避免再次肝移植。

关键词: 肝动脉血栓形成, 肝移植, 再血管化, 溶栓, 并发症

Abstract:

BACKGROUND: Hepatic artery thrombosis (HAT) is the main reason for graft loss or recipients death after liver transplantation although liver transplantation technology has been maturated.
OBJECTIVE: To summarize the treatment for HAT after orthotopic liver transplantation. 
METHODS: A total of 726 adult patients received liver transplantation at the Department of Organ Transplantation, the First Affiliated Hospital of Sun Yat-sen University from January 2004 to December 2009 were selected. Fourteen patients suffered from HAT after the operation, the clinical data of these patients were analyzed retrospectively.
RESULTS AND CONCLUSION: The incidence rate of HAT was 1.9% (14/726), mean time of the onset was 10 days (1 -41 days) postoperatively. Six of them had acute liver function deterioration, 4 had bile leakage, 1 had hepatic abscess and 3 had no symptoms. Three patients received urgent rearteriarization, 2 received intra-arterial thrombolysis, 3 received combined urgent rearteriarization and intra-arterial thrombolysis, and 6 patients received retransplantation. Mortality rate associated with HAT was 42.9% (6/14), 2 from biliary necrosis and secondary hepatic failure after urgent rearteriarization, 1 from recurrence of HAT and multiple organ failure after intra-arterial thrombolysis, 1 from renal failure and severe infection after combined urgent rearteriarization and intra-arterial thrombolysis, 2 from severe infection after retransplantation. The other patients recovered and were followed up 18-66 months. Their liver grafts were all functioning well with patent artery, 2 died from tumor recurrence at 18 and 29 month after transplantation. HAT is a severe complication after liver transplantation, which leads to graft loss and recipients’ death. Rearteriarization as early as possible before irreversible biliary and liver parenchyma damage can avoid retransplantation.

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