Gao Peng Ji, Zhu Ji Ye, Li Guang Ming, Leng Xi Sheng
Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing 100044, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2009 Oct 18;41(5):558-60.
To investigate the outcome of liver transplantation(LT) for end stage liver disease with portal vein thrombosis (PVT) in different processes.
Data from 308 patients who underwent LT from July 2004 to February 2008 were retrospectively assessed. The processes of varies grades of PVT during LT were analyzed and estimated for whether the outcome of LT was different between patients with or without PVT.
There were 46 patients with PVT, including 11 of grade 1, 14 of grade 2, 18 of grade 3 and 3 of grade 4. LT performed in grade 1 and 2 PVT patients without special intervention. LT was performed in 16 patients with grade 3 PVT after simple thrombectomy or thrombus-extraction. The other 2 patients with grade 3 PVT received the donor superior mesenteric vein to act as a bridge between the donor portal vein and host superior mesenteric vein. Two cases with grade 4 PVT received a cavo-portal hemitransposition, and the other one anastomosis between graft portal vein and varicose coronary vein. The postoperative 1-year survival rates of patients without PVT and patients with PVT were 91.6%(240/262), 80.5%(211/262)vs 86.9%(40/46), 76.1%(35/46), respectively. The patients with PVT had a recurrence rate of 4.3%(2/46).
Most patients suffering from end stage liver disease with PVT can be successfully treated by LT. However, the result of the patients with diffused PVT undergoing LT is relatively poor.
探讨不同病程的门静脉血栓形成(PVT)终末期肝病患者肝移植(LT)的疗效。
回顾性分析2004年7月至2008年2月行LT的308例患者的数据。分析并评估LT期间不同程度PVT的病程,比较有无PVT患者的LT疗效是否存在差异。
46例患者存在PVT,其中1级11例,2级14例,3级18例,4级3例。1级和2级PVT患者无需特殊干预即可行LT。16例3级PVT患者在单纯血栓切除术或血栓清除术后行LT。另外2例3级PVT患者接受供体肠系膜上静脉作为供体门静脉与宿主肠系膜上静脉之间的桥梁。2例4级PVT患者接受腔门静脉半转位术,另1例接受移植门静脉与曲张冠状静脉吻合术。无PVT患者和有PVT患者术后1年生存率分别为91.6%(240/262)、80.5%(211/262)与86.9%(40/46)、76.1%(35/46)。有PVT患者的复发率为4.3%(2/46)。
大多数合并PVT的终末期肝病患者可通过LT成功治疗。然而,弥漫性PVT患者行LT的效果相对较差。