Adani Gian Luigi, Baccarani Umberto, Risaliti Andrea, Sponza Massimo, Gasparini Daniele, Bresadola Fabrizio, de Anna Dino, Bresadola Vittorio
Department of Surgery & Transplantation, University Hospital of Udine, Via Colugna 50, 33100 Udine, Italy.
Cardiovasc Intervent Radiol. 2007 Nov-Dec;30(6):1222-6. doi: 10.1007/s00270-007-9056-z. Epub 2007 Jun 18.
We treated three cases of early portal vein thrombosis (PVT) by minimally invasive percutaneous transhepatic portography. All patients developed PVT within 30 days of major hepatic surgery (one case each of orthotopic liver transplantation, splenectomy in a previous liver transplant recipient, and right extended hepatectomy with resection and reconstruction of the left branch of the portal vein for tumor infiltration). In all cases minimally invasive percutaneous transhepatic portography was adopted to treat this complication by mechanical fragmentation and pharmacological lysis of the thrombus. A vascular stent was also positioned in the two cases in which the thrombosis was related to a surgical technical problem. Mechanical fragmentation of the thrombus with contemporaneous local urokinase administration resulted in complete removal of the clot and allowed restoration of normal blood flow to the liver after a median follow-up of 37 months. PVT is an uncommon but severe complication after major surgery or liver transplantation. Surgical thrombectomy, with or without reconstruction of the portal vein, and retransplantation are characterized by important surgical morbidity and mortality. Based on our experience, minimally invasive percutaneous transhepatic portography should be considered an option toward successful recanalization of early PVT after major liver surgery including transplantation. Balloon dilatation and placement of a vascular stent could help to decrease the risk of recurrent thrombosis when a defective surgical technique is the reason for the thrombosis.
我们采用微创经皮肝门静脉造影术治疗了3例早期门静脉血栓形成（PVT）患者。所有患者均在大型肝脏手术后30天内发生PVT（分别为1例原位肝移植、1例既往肝移植受者行脾切除术、1例因肿瘤浸润行右半肝扩大切除术并门静脉左支切除重建）。在所有病例中，均采用微创经皮肝门静脉造影术，通过机械碎栓和药物溶栓来治疗这一并发症。对于血栓形成与手术技术问题相关的2例患者，还放置了血管支架。采用机械碎栓并同期局部应用尿激酶，中位随访37个月后，血栓完全清除，肝脏恢复正常血流。PVT是大型手术或肝移植后一种少见但严重的并发症。门静脉血栓切除术，无论是否进行门静脉重建，以及再次移植，均具有较高的手术并发症发生率和死亡率。根据我们的经验，对于包括移植在内的大型肝脏手术后早期PVT的成功再通，微创经皮肝门静脉造影术应被视为一种选择。当手术技术缺陷是血栓形成的原因时，球囊扩张和放置血管支架有助于降低复发血栓形成的风险。
