Egawa Hiroto, Tanaka Koichi, Kasahara Mureo, Takada Yasutsugu, Oike Fumitaka, Ogawa Kohei, Sakamoto Seisuke, Kozaki Koichi, Taira Kaoru, Ito Takashi
Organ Transplant Unit, Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan.
Liver Transpl. 2006 Oct;12(10):1512-8. doi: 10.1002/lt.20777.
Living donor liver transplantation (LDLT) for patients with portal vein thrombosis (PVT) involves technical difficulty. The aim of this research was to analyze their preoperative diagnosis of PVT, operative procedures, and postoperative courses of patients with preoperative PVT. Thirty-nine patients of 404 adult patients (9.7%) undergoing LDLT in our hospital from 1996 June to 2004 December had PVT at their transplantation. Twenty-nine patients had intractable ascites, 21 had gastrointestinal bleeding, and 18 had encephalopathy. The thrombus was located in the portal trunk in 23, in the portal trunk and superior mesenteric vein (SMV) in 7, and developed into the SMV and the splenic vein in 8. The occlusive grade was partial in 29, and complete in 10 patients. The thrombus was removed by a simple technique, and eversion and/or incision technique, or total removal of the portal vein (PV). The PV was reconstructed with the thrombectomized native PV, with an interposed vein graft, or porto-caval hemitransposition. Advanced PVT had a significant impact on blood loss and hospital mortality. Three out of 10 patients with residual PVT required radiological and/or surgical intervention after transplantation. In conclusion, thorough planning is essential for a successful LDLT outcome for patients with preexisting PVT.
对门静脉血栓形成（PVT）患者进行活体供肝肝移植（LDLT）存在技术难度。本研究的目的是分析术前诊断为PVT的患者的术前诊断、手术过程及术后病程。1996年6月至2004年12月在我院接受LDLT的404例成年患者中，39例（9.7%）在移植时有PVT。29例患者有顽固性腹水，21例有胃肠道出血，18例有脑病。血栓位于门静脉主干23例，位于门静脉主干和肠系膜上静脉（SMV）7例，发展至SMV和脾静脉8例。闭塞程度为部分闭塞29例，完全闭塞10例。通过简单技术、外翻和/或切开技术或完全切除门静脉（PV）来清除血栓。用切除血栓的自体PV、置入静脉移植物或门静脉-腔静脉半转位重建PV。进展期PVT对失血量和医院死亡率有显著影响。10例残留PVT患者中有3例在移植后需要进行放射学和/或手术干预。总之，对于已有PVT的患者，全面规划对于成功的LDLT结果至关重要。
