Lorenz Jonathan M, Van Ha Thuong, Funaki Brian, Millis Michael, Leef Jeffrey A, Bennett Andrew, Rosenblum Jordan
Department of Radiology, The University of Chicago, 5841 South Maryland Avenue, MC2026, Chicago, Illinois 60637, USA.
J Vasc Interv Radiol. 2006 Nov;17(11 Pt 1):1753-61. doi: 10.1097/01.RVI.0000241540.31081.52.
To evaluate the efficacy and safety of percutaneous dilation in the treatment of impaired venous outflow in pediatric patients with liver transplants.
Review was undertaken of the records of 35 procedures to dilate impaired venous outflow in 16 consecutive children (aged 11 days to 17.8 years; mean, 7.2 +/- 5.8 y) after liver transplantation over a period of 8 years. Patients presented clinically with signs or symptoms of obstruction of the hepatic venous or inferior vena cava anastomosis and/or abnormal noninvasive imaging findings and were referred primarily to the interventional radiology department for treatment. None were excluded. Technical and clinical success rates were calculated. After venoplasty, patients with incomplete venographic resolution or pressure gradients exceeding 5 mm Hg were treated with stents. Seven died or required repeat transplantation during the study period for reasons unrelated to venous outflow obstruction. Patency rates were calculated for all other patients with sufficient follow-up in the pediatric hepatology clinic.
The combined technical success rate for venoplasty (12 of 16) and stent placement (three of 16) was 94% (15 of 16), and the clinical success rate was 81% (13 of 16). One minor complication occurred: a transient hypoxic episode. Primary patency rates were 72.7% (eight of 11) at 3 months, 60% (six of 10) at 6 months, 55.6% (five of nine) at 12 months, 50% (four of eight) at 18 months, and 50% (three of six) at 36 months. Primary assisted and secondary patency rates were 90.9% (10 of 11) at 3 months, 90% (nine of 10) at 6 months, 88.9% (eight of nine) at 12 months, 87.5% (seven of eight) at 18 months, and 83.3% (five of six) at 36 months.
Excellent technical and clinical success rates can be achieved with percutaneous dilation of impaired venous outflow after pediatric liver transplantation. Long-term patency may require repeated interventions.
评估经皮扩张术治疗小儿肝移植患者静脉流出道受损的疗效和安全性。
回顾了8年间16例连续儿童（年龄11天至17.8岁；平均7.2±5.8岁）肝移植后35例扩张静脉流出道受损的手术记录。患者临床上表现为肝静脉或下腔静脉吻合口梗阻的体征或症状和/或非侵入性影像学检查结果异常，主要转诊至介入放射科进行治疗。无一例被排除。计算技术成功率和临床成功率。静脉成形术后，静脉造影显示未完全恢复或压力梯度超过5 mmHg的患者接受支架治疗。7例在研究期间因与静脉流出道梗阻无关的原因死亡或需要再次移植。对小儿肝病门诊所有有足够随访资料的其他患者计算通畅率。
静脉成形术（16例中的12例）和支架置入术（16例中的3例）的综合技术成功率为94%（16例中的15例），临床成功率为81%（16例中的13例）。发生1例轻微并发症：短暂缺氧发作。3个月时的原发性通畅率为72.7%（11例中的8例），6个月时为60%（10例中的6例），12个月时为55.6%（9例中的5例），18个月时为50%（8例中的4例），36个月时为50%（6例中的3例）。3个月时的原发性辅助通畅率和继发性通畅率为90.9%（11例中的10例），6个月时为90%（10例中的9例），12个月时为88.9%（9例中的8例），18个月时为87.5%（8例中的7例），36个月时为83.3%（6例中的5例）。
小儿肝移植后经皮扩张静脉流出道受损可取得优异的技术和临床成功率。长期通畅可能需要重复干预。
Zotero 插件