Department of Surgery, The Catholic University of Korea, Seocho-Goo, Seoul, Korea.
Clin Transplant. 2011 Jan-Feb;25(1):111-8. doi: 10.1111/j.1399-0012.2010.01217.x.
The aim of this study was to improve outcomes in living donor liver transplantation (LDLT) patients with portal vein thrombosis (PVT). Of 246 adult patients who underwent LDLT with a right lobe graft between January 2000 and May 2007, PVT was diagnosed in 50 patients (20.3%), who were further subdivided into partial (n = 39, 78%) and complete (n = 11, 22%) types. Patients with PVT, especially complete PVT, showed high incidences of variceal bleeding (p = 0.021), operative RBC transfusion (p < 0.046) and a post-transplantation complications related to bleeding (p = 0.058). We also classified PVT according to its location and the presence of collaterals: type I (n = 41, 82%): PVT localized above the confluence of the splenic and superior mesenteric veins (SMV); type II (n = 7, 14%): PVT extending below the confluence with a patent distal SMV; type III (n = 2, 4%): complete portal vein and SMV thrombosis except for a coronary vein. LDLT could be safely undertaken in patients with PVT without increased mortality. In our type II and III PVT, when thrombectomy fails, jump grafting using a cryopreserved vessel may serve as a reliable alternative method to restore portal flow.
本研究旨在改善门静脉血栓形成（PVT）患者活体肝移植（LDLT）的预后。2000 年 1 月至 2007 年 5 月期间，246 例成人接受右叶活体肝移植，其中 50 例（20.3%）诊断为 PVT，进一步分为部分性（n=39，78%）和完全性（n=11，22%）。PVT 患者，尤其是完全性 PVT，显示出较高的静脉曲张出血发生率（p=0.021）、手术红细胞输注（p<0.046）和与出血相关的移植后并发症发生率（p=0.058）。我们还根据 PVT 的位置和侧支循环的存在对其进行分类：I 型（n=41，82%）：PVT 局限于脾静脉和肠系膜上静脉汇合处以上；II 型（n=7，14%）：PVT 延伸至汇合处以下，但有通畅的远端 SMV；III 型（n=2，4%）：除冠状静脉外，门静脉和 SMV 完全血栓形成。PVT 患者行 LDLT 不会增加死亡率。在我们的 II 型和 III 型 PVT 中，如果血栓切除术失败，使用冷冻保存血管进行跳跃移植可能是恢复门静脉血流的可靠替代方法。
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