Ma Yi, He Xiao-shun, Zhu Xiao-feng, Wang Guo-dong, Wang Dong-ping, Ju Wei-qiang, Wu Lin-wei, Hu An-bin, Tai Qiang
Department of Transplantation Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
Zhonghua Wai Ke Za Zhi. 2008 Aug 1;46(15):1133-5.
To investigate the causes and treatment of postoperative venous outflow obstruction after orthotopic liver transplantation (OLT).
Clinical data of 776 patients after OLT were analyzed retrospectively between January 2000 and December 2006. The accumulated experiences in diagnosis and treatment of postoperative outflow obstruction after OLT were reviewed.
Venous outflow obstruction occurred in 10 patients (1.29%) after OLT, among those 6 had supra-hepatic inferior vena cava (IVC) stenosis, 2 had IVC stenosis of the post-hepatic segment, and 2 had outflow obstruction of hepatic vein. The diagnosis was confirmed by inferior vena cavography in all the patients. Of the 10 patients, 8 received percutaneous transluminal angioplasty (PTA) or metallic stent replacement, and 2 underwent liver retransplantation (re-LT) when interventional therapy failed. Three patients died from outflow obstruction, so the outflow obstruction related mortality was 30% in the patients.
Complications of outflow obstruction after OLT were associated with surgical technique like vascular anastomosis, various types of cavo-caval anastomosis and graft size mismatch between donor and recipient. Making an early diagnosis and giving timely treatment including interventional therapy or re-LT is the key to improve the prognosis of outflow obstruction.
探讨原位肝移植（OLT）术后静脉流出道梗阻的原因及治疗方法。
回顾性分析2000年1月至2006年12月期间776例行OLT患者的临床资料。总结OLT术后流出道梗阻的诊断和治疗经验。
OLT术后10例患者（1.29%）发生静脉流出道梗阻，其中6例为肝上下腔静脉（IVC）狭窄，2例为肝后段IVC狭窄，2例为肝静脉流出道梗阻。所有患者均经下腔静脉造影确诊。10例患者中，8例行经皮腔内血管成形术（PTA）或金属支架置入术，2例介入治疗失败后行再次肝移植（re-LT）。3例患者死于流出道梗阻，因此流出道梗阻相关死亡率为30%。
OLT术后流出道梗阻并发症与血管吻合等手术技术、各种类型的腔静脉吻合以及供受体之间的移植物大小不匹配有关。早期诊断并及时给予包括介入治疗或re-LT在内的治疗是改善流出道梗阻预后的关键。
