Kubo Takeshi, Shibata Toshiya, Itoh Kyo, Maetani Yoji, Isoda Hiroyoshi, Hiraoka Masahiro, Egawa Hiroto, Tanaka Koichi, Togashi Kaori
Department of Radiology, Kyoto University Graduate School of Medicine, 54-Kawaharacho, Shogoin, Sakyoku, Kyoto 606-8507, Japan.
Radiology. 2006 Apr;239(1):285-90. doi: 10.1148/radiol.2391050387.
To evaluate retrospectively the outcome of percutaneous transhepatic venoplasty of hepatic venous outflow obstruction after living donor liver transplantation (LDLT).
The institutional Human Subjects Research Review Board approved the interventional protocol and the retrospective study, for which informed consent was not required. Before treatment, informed consent was obtained from the patient or the patient's parents in all cases. Of 26 consecutive patients (nine male, 17 female; median age, 9 years) suspected of having hepatic venous outflow obstruction after LDLT, 20 patients confirmed to have anastomotic outflow stenosis at percutaneous hepatic venography and manometry underwent venoplasty. Pressure gradients before and after venoplasty were evaluated by using a paired t test. Patients in whom obstruction recurred during follow-up were re-treated with venoplasty with or without expandable metallic stents. Patency was analyzed by using Kaplan-Meier analysis.
The initial balloon venoplasty was technically successful in all 20 patients, all of whom had improved clinical findings. The pressure gradient +/- standard deviation was reduced from 14.6 mg Hg +/- 8.6 to 2.2 mg Hg +/- 2.4 (P < .001). Eleven patients had recurrent obstruction and were treated with balloon venoplasty; one of them underwent stent placement, as well as venoplasty. The primary (event-free) patency and 95% confidence interval (CI) at 3, 12, and 60 months after venoplasty were 0.80 (95% CI: 0.62, 0.98), 0.60 (95% CI: 0.38, 0.81), and 0.60 (95% CI: 0.38, 0.81), respectively. The primary assisted patency, maintained with repeated venoplasty and expandable metallic stents, was 1.00 at 60 months.
Percutaneous venoplasty is an effective treatment for hepatic venous outflow obstruction after LDLT.
回顾性评估活体肝移植（LDLT）后经皮肝静脉成形术治疗肝静脉流出道梗阻的疗效。
机构人类受试者研究审查委员会批准了介入方案和回顾性研究，该研究无需知情同意。治疗前，所有病例均获得患者或患者父母的知情同意。在26例连续怀疑LDLT后发生肝静脉流出道梗阻的患者中（9例男性，17例女性；中位年龄9岁），20例经皮肝静脉造影和测压确诊为吻合口流出道狭窄的患者接受了静脉成形术。采用配对t检验评估静脉成形术前和术后的压力梯度。随访期间梗阻复发的患者接受了带或不带可扩张金属支架的静脉成形术再治疗。采用Kaplan-Meier分析评估通畅情况。
所有20例患者首次球囊静脉成形术技术均成功，所有患者临床症状均改善。压力梯度±标准差从14.6 mmHg±8.6降至2.2 mmHg±2.4（P<.001）。11例患者出现复发性梗阻并接受了球囊静脉成形术治疗；其中1例患者除接受静脉成形术外还置入了支架。静脉成形术后3个月、12个月和60个月的主要（无事件）通畅率及95%置信区间（CI）分别为0.80（95%CI：0.62，0.98）、0.60（95%CI：0.38，0.81）和0.60（95%CI：0.38，0.81）。通过重复静脉成形术和可扩张金属支架维持的主要辅助通畅率在60个月时为1.00。
经皮静脉成形术是治疗LDLT后肝静脉流出道梗阻的有效方法。
