Cheng Yu Fan, Chen Chao Long, Huang Tung L, Chen Tai Yi, Chen Yaw Sen, Wang Chih Chi, Tsang Leo Leung-Chit, Sun Po Lin, Chiu King Wah, Eng Hock-Liew, Jawan Bruno
Department of Diagnostic Radiology and Liver Transplant program, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University, Kaohsiung, Taiwan.
Transpl Int. 2005 May;18(5):556-61. doi: 10.1111/j.1432-2277.2005.00088.x.
We reviewed long-term results of percutaneous venoplasty in children with hepatic vein stenosis after partial liver transplants, of which excellent early results were shown. Percutaneous transjugular hepatic venoplasty using balloon dilatation or stent implantation was performed in six cases with hepatic vein stenosis identified on routine post-transplant Doppler sonography and confirmed by transjugular hepatic venography from 1994 to 2003. Repeated procedure was carried out if necessary. Six of 105 patients with partial liver graft developed hepatic stenosis characterized by low hepatic venous velocity with monophasic waveform with significant pressure gradient (>5 mmHg). The incidence was 4.46% for all 112 pediatric liver transplants. Successful balloon venoplasty was achieved in four cases. Self-expanding stent was used in two cases with absent waisting or angulated balloon catheter during dilatation and persisted pressure gradient (>5 mmHg). Repeated procedure was required in two initially successful cases with additional stent used in one case. Three cases had transient hyperdynamic hepatic venous flow with markedly increased central venous pressure after stent implantation. Nonprocedural-related mortality rate was 16.7%. Patent hepatic vein was maintained in five patients after a mean follow-up of 3.67 years (0.75-9.5). Higher incidence of hepatic vein stenosis was noted in pediatric partial liver transplant. However, encouraging long-term results showed that hepatic venoplasty or stent implantation could be a preferable alterative to surgical revision or retransplantation, which has been the procedure of choice in our hospital.
我们回顾了部分肝移植术后肝静脉狭窄患儿经皮静脉成形术的长期结果，早期结果显示良好。1994年至2003年期间，对6例经常规移植后多普勒超声检查发现肝静脉狭窄并经经颈肝静脉造影证实的患儿，采用球囊扩张或支架植入术进行经颈肝静脉成形术。必要时进行重复操作。105例接受部分肝移植的患者中有6例出现肝静脉狭窄，其特征为肝静脉血流速度低、呈单相波形且压力梯度显著（>5 mmHg）。在所有112例小儿肝移植中，发生率为4.46%。4例成功进行了球囊静脉成形术。2例在扩张过程中出现球囊导管无腰或成角且压力梯度持续存在（>5 mmHg）的情况，使用了自膨式支架。2例最初成功的病例需要重复操作，其中1例额外使用了支架。3例在植入支架后出现短暂的高动力性肝静脉血流，中心静脉压明显升高。非手术相关死亡率为16.7%。平均随访3.67年（0.75 - 9.5年）后，5例患者的肝静脉保持通畅。小儿部分肝移植中肝静脉狭窄的发生率较高。然而，令人鼓舞的长期结果表明，肝静脉成形术或支架植入术可能是手术修正或再次移植的更好替代方法，而手术修正或再次移植一直是我院的首选治疗方法。
