Jeng K-S, Huang C-C, Lin C-K, Lin C-C, Chen K-H
Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan.
Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan.
Transplant Proc. 2014 Apr;46(3):841-4. doi: 10.1016/j.transproceed.2013.11.095.
Intrahepatic segmental portal vein thrombosis after living-related liver transplantation (LRLT) is uncommon. The cause remains unclear.
After providing written informed consent, 25 recipients receiving LRLT at our institution from January 2011 to September 2013 were enrolled in this study. We performed triphase computerized tomographic (CT) study of the liver graft of each recipient 1 month after LRLT. The patencies of hepatic artery, portal vein, and hepatic vein were evaluated in detail. The triphase CT scans of the liver of each donor before transplantation also were reviewed. Thrombosis of the intrahepatic segmental portal vein was defined as the occlusion site of the portal vein being intrahepatic. Extrahepatic portal vein thrombosis was excluded in this study.
Among the 25 patients, 2 (8%) developed thrombosis of intrahepatic segmental portal vein. One 47-year-old man received LRLT for hepatitis B viral infection-related liver cirrhosis (Child-Pugh class C) with 3 hepatocellular carcinomas (total tumor volume <8 cm). Another 53-year-old man received LRLT for alcoholic liver cirrhosis (Child-Pugh class C). Both had developed progressive jaundice and cholangitis 1 month after surgery. Intrahepatic biliary stricture was found on the follow-up magnetic resonance images. However, liver triphase CT study demonstrated occlusion of intrahepatic portal vein of segment 8 in each patient. Radiologic interventions and balloon dilatation therapy via percutaneous transhepatic biliary drainage route improved the symptoms and signs of cholangitis and obstructive jaundice for both.
Thrombosis of intrahepatic segmental portal vein is not common but is usually associated with complications of intrahepatic bile duct. Early detection is important, and follow-up CT study of liver is suggested.
活体肝移植（LRLT）后肝内节段性门静脉血栓形成并不常见。病因尚不清楚。
在获得书面知情同意后，2011年1月至2013年9月在我院接受LRLT的25例受者纳入本研究。我们在LRLT术后1个月对每位受者的肝移植进行了三期计算机断层扫描（CT）研究。详细评估肝动脉、门静脉和肝静脉的通畅情况。还回顾了每位供者术前肝脏的三期CT扫描结果。肝内节段性门静脉血栓形成定义为门静脉闭塞部位在肝内。本研究排除肝外门静脉血栓形成。
25例患者中，2例（8%）发生肝内节段性门静脉血栓形成。1例47岁男性因乙型肝炎病毒感染相关肝硬化（Child-Pugh C级）伴3个肝细胞癌（肿瘤总体积<8 cm）接受LRLT。另1例53岁男性因酒精性肝硬化（Child-Pugh C级）接受LRLT。两人术后1个月均出现进行性黄疸和胆管炎。随访磁共振成像发现肝内胆管狭窄。然而，肝脏三期CT研究显示每位患者的肝内门静脉8段闭塞。通过经皮经肝胆道引流途径的放射介入和球囊扩张治疗改善了两人的胆管炎和梗阻性黄疸的症状和体征。
肝内节段性门静脉血栓形成并不常见，但通常与肝内胆管并发症相关。早期检测很重要，建议对肝脏进行随访CT研究。
