术前门静脉血栓对活体肝移植预后的影响

王永磊,杨涛,朱志军等.术前门静脉血栓对活体肝移植预后的影响[J].中华普通外科杂志.2013, 28(3):189-192

肝移植; 活体供者; 血栓形成; 门静脉

王永磊,杨涛,朱志军,孙丽莹,曾志贵

300070天津医科大学 一 中心临床学院;天津市笫一中心医院肝移植中心

0

189-192

知网,万方

目的 探讨术前门静脉血栓对活体肝移植的影响。方法 回顾性分析天津市第一中心医院2007至2011年完成的99例成人闸活体肝移植患者,根据术前是否有闸静脉血栓分为2组 , 血栓组26例,无血栓组73例。比较2组的术前危险因素及门静脉血栓对活体肝移植手术和术后患者预后的影响。 结果 26例门静脉血栓患者 I级血栓23例,Ⅱ 级血栓3例。肝移植术前的脾切除是发生闸 静脉血栓的 独立危险囚素(X2=10.211,P=0.001)。 术前门 静脉血栓会延长手术的无肝期 (z=-2.430,P=0.015),但 2组患者术后并发症发生率(X2=0.326,P=0.568)及死亡率均无统计学差异,而且对患者的1年生存率和3年牛存率均无影响(X2=0.505,P=0.477)。 结论 对于活体肝移植合并 I级或 Ⅱ级闸静脉血栓的患者,通过合理的术中处理及术后预防,门静脉血栓不会影响患者的预后。但门静脉血栓增加了一定的手术难度,需要详尽的术前评估和仔细的术中操作。 Objective To investigate the impact of preoperative portal vein thrombosis(PPVT)on living donor 1iver transplantation(LDLT) .Methods In this study,99patlents who underwent LDLT by the same surgical team of Tiajin First Centre Hospital flom2007to2011were retrospectively analyzed According to whether there was a PPV T,a11 the patient. Were divided into PPVT group(26cases) and non~ PPVT group(73cases), The preoperative risk factors and the impact of PPVT on LDLT and outcomces were analyzed. Results Among 26 PPVT patients there were23 cases in grade I and3 cases in grade Ⅱ splenectomy was found to be an independent risk factor br PPVT (x2=10.211, P=0.001) PPVT pro1onged the anhepatic phase(z=-2.430,P=0.015),but the incidence of surical comp1ications and mortality were no statistical differences between the PVT group and the non-PVT groups. Meanwhi1e, there Was no statistical difference of 1-and3-year surviva1rate between the two groups(x2=0.505,P=0.477) Conclusions with proper intraoperative treatment and postoperative prevention, PPVT does not affect the outcomes of patlents suffering from grade I or Ⅱ PPVT . However,PPVT added to difficulties of operation, so the detailed preoperative evaluation and careful intraoperative operation is necessary.