Sarfati P O, Boillot O, Baudin F, Laurent J, Houssin D, Chapuis Y
Clinique Chirurgicale, Hôpital Cochin, Paris.
Ann Chir. 1992;46(7):605-9.
In pediatric liver transplantation, hepatic artery thrombosis usually leads to graft loss, early due to hepatic necrosis when it occurs during the first week following the transplant procedure, or later due to biliary complications. Liver retransplantation is the usual attitude. However, urgent surgical hepatic arterial thrombectomy to restore the blood flow can be successful when early diagnosis is made with Doppler ultrasound examination and angiography. Four hepatic arterial thrombectomies were performed as an emergency with additional intra-hepatic arterial fibrinolytic treatment, in three children, 1.5, 3 and 5.5 years of age. Mean duration between the first signs of hepatic artery thrombosis and thrombectomy was 16 hours. None of the children had an urgent liver retransplantation. A complete success was obtained in one case, with normal liver function tests and patent hepatic artery on the Doppler ultrasound examination at the present time. In the two other cases, hepatic artery thrombosis recurred, in spite of repeated thrombectomy in one case; following this attempt complications of hepatic artery thrombosis occurred in the two patients: ischemic necrosis of the left lobe (1 case), biliary leak (1 case) and stenosis of the common bile duct (2 cases). A complete success in one case and a partial success in the two others lead us to advocate urgent thrombectomy and in situ fibrinolytic treatment when early diagnosis of hepatic artery thrombosis is made.
在小儿肝移植中，肝动脉血栓形成通常会导致移植物丧失，若在移植手术后第一周内发生，早期会因肝坏死而导致移植物丧失，后期则会因胆道并发症而导致移植物丧失。再次肝移植是常用的处理方式。然而，当通过多普勒超声检查和血管造影早期诊断时，紧急进行外科肝动脉血栓切除术以恢复血流可能会成功。对3名年龄分别为1.5岁、3岁和5.5岁的儿童进行了4次紧急肝动脉血栓切除术，并辅以肝内动脉溶栓治疗。肝动脉血栓形成的最初症状与血栓切除术之间的平均间隔时间为16小时。这些儿童均未进行紧急再次肝移植。1例获得了完全成功，目前肝功能检查正常，多普勒超声检查显示肝动脉通畅。在另外2例中，尽管其中1例进行了反复血栓切除术，但肝动脉血栓仍复发；在这两次尝试后，两名患者均出现了肝动脉血栓形成的并发症：左叶缺血性坏死（1例）、胆漏（1例）和胆总管狭窄（2例）。1例完全成功，另外2例部分成功，这使我们主张在早期诊断肝动脉血栓形成时进行紧急血栓切除术和原位溶栓治疗。
