Cavallari A, Vivarelli M, Bellusci R, Jovine E, Mazziotti A, Rossi C
Clinica Chirurgica II, Policlinico S. Orsola, Via Massarenti 9, 40138 Bologna, Italy.
Hepatogastroenterology. 2001 Jan-Feb;48(37):179-83.
BACKGROUND/AIMS: Complications affecting the vascularization of the graft following orthotopic liver transplantation still represent a significant cause of graft loss and patient mortality. Strategies have recently been developed for the early detection and treatment of these complications before irreversible graft failure takes place.
A series of 429 consecutive liver transplants performed on 384 patients between April 1986 and December 1998 was retrospectively reviewed to assess the incidence of all the vascular complications and the results of their treatment with either surgery or interventional radiology.
The incidence of vascular complications was 6.06% for the hepatic artery, 2.56% for the inferior vena cava and 1.16% for the portal vein. As regards anastomotic stenosis and thrombosis, the requirement of retransplantation decreased progressively with the advent of systematic postoperative screening with duplex Doppler ultrasonography and the introduction of graft-salvage procedures, falling from 50% for those cases diagnosed before 1996 to 19% for those diagnosed from 1996 on. Mortality following 18 graft-salvage procedures was 11.1% versus 41.6% following retransplantation. Graft-salvage procedures were successful in 14 out of 18 cases.
Close surveillance of the vascular anastomoses and multidisciplinary approach to the treatment of vascular complication after liver transplantation considerably reduces graft loss and patient mortality.
背景/目的：原位肝移植后影响移植物血管化的并发症仍是移植物丢失和患者死亡的重要原因。最近已制定策略，以便在不可逆转的移植物衰竭发生之前对这些并发症进行早期检测和治疗。
回顾性分析了1986年4月至1998年12月期间在384例患者身上进行的429例连续肝移植病例，以评估所有血管并发症的发生率以及手术或介入放射学治疗的结果。
肝动脉血管并发症的发生率为6.06%，下腔静脉为2.56%，门静脉为1.16%。关于吻合口狭窄及血栓形成，随着术后双功多普勒超声系统筛查的出现以及移植物挽救手术的引入，再次移植的需求逐渐降低，从1996年前诊断的病例中的50%降至1996年及以后诊断病例中的19%。18例移植物挽救手术后的死亡率为11.1%，而再次移植后的死亡率为41.6%：18例病例中有14例移植物挽救手术成功。
肝移植后对血管吻合口进行密切监测以及对血管并发症采取多学科治疗方法可显著降低移植物丢失和患者死亡率。
