Glanemann M, Settmacher U, Langrehr J M, Kling N, Hidajat N, Stange B, Staffa G, Bechstein W O, Neuhaus P
Department of Surgery, Charité, Humboldt University Berlin, Germany.
Transpl Int. 2001;14(1):48-51. doi: 10.1007/s001470050742.
Symptomatic portal vein stenosis is an uncommon complication after liver transplantation. Portal vein angioplasty has been successfully established for treatment of portal vein stenosis using mesenteric or percutaneous, transhepatic approaches. We herein report on a patient who suffered from variceal bleeding due to portal hypertension 3 months after liver transplantation. After successful endoscopic sclerotherapy, an extrahepatic portal vein stenosis was diagnosed, and portal vein angioplasty was considered as primary therapeutic option. Instead of mesenteric or percutaneous, transhepatic approaches, we adopted a transjugular, intrahepatic access to introduce a 14-mm balloon catheter into the portal vein. Using this technique, angioplasty was successfully performed. After intervention, no further episodes of variceal bleeding occurred. We favour the transjugular, intrahepatic technique for portal vein angioplasty because it does not require general anesthesia, in contrast to the mesenteric approach, and it reduces the risk of intra-abdominal bleeding, compared to the percutaneous, transhepatic approach.
有症状的门静脉狭窄是肝移植后一种罕见的并发症。门静脉血管成形术已成功用于治疗门静脉狭窄，可采用肠系膜或经皮经肝途径。我们在此报告一例肝移植术后3个月因门静脉高压导致静脉曲张出血的患者。在内镜硬化治疗成功后，诊断为肝外门静脉狭窄，门静脉血管成形术被视为主要治疗选择。我们没有采用肠系膜或经皮经肝途径，而是采用经颈静脉肝内入路将一根14毫米的球囊导管插入门静脉。使用该技术，成功进行了血管成形术。干预后，未再发生静脉曲张出血事件。我们支持经颈静脉肝内技术用于门静脉血管成形术，因为与肠系膜途径相比，它不需要全身麻醉，与经皮经肝途径相比，它降低了腹腔内出血的风险。
