Chang Wen-Tsan, Kuo Yu-Ting, Lee King-Teh, Shih Ming-Chen, Huang Jian-Wei, Su Wen-Lung, Chen Chau-Yun, Huang Yu-Ling, Wang Shen-Nien, Chuang Shih-Chang, Kuo Kung-Kai, Chen Jong-Shyone
Division of Hepatobiliarypancreatic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Radiology, Chi-Mei Hospital, Tainan, Taiwan.
Kaohsiung J Med Sci. 2016 Mar;32(3):128-34. doi: 10.1016/j.kjms.2016.02.003. Epub 2016 Mar 16.
If portal vein stenosis (PVS) occurs within 1 month after liver transplantation (LT), especially within 1 week, it can be catastrophic and result in rapid loss of the grafts and mortality. Although surgical treatments have been considered standard treatment for PVS, patients are usually unable to receive operations or re-transplantations, because of their critical conditions and a shortage of grafts. Recently, primary percutaneous transhepatic portal vein stents (PTPS) were suggested as alternative and less-invasive treatments of PVS. However, because lethal complications may follow these primary stent placements for patients in early stages after LT, primary PTPS placements for patients suffering PVS 1 month after LT has been suggested. From November 2009 to July 2015, 38 consecutive adult patients underwent LT at our institution. Among them, six recipients suffered PVS within 1 month after LT. Technical success was achieved in all six patients. Clinical success was obtained in two of the four patients suffering PVS within 1 week after LT, and in the other two patients suffering PVS>1 week after LT. All surviving patients and their grafts were in good condition, and their stents remained patent. Our experience showed that primary PTPS placements can be used to effectively treat patients with PVS encountered within 1 month, and even within 1 week, after LT with acceptable short-term results. However, possible fatal complications should be kept in mind. Long-term results of these procedures need further follow-up.
如果门静脉狭窄（PVS）发生在肝移植（LT）后1个月内，尤其是1周内，可能是灾难性的，会导致移植物迅速丧失和死亡。尽管手术治疗一直被视为PVS的标准治疗方法，但由于患者病情危急且供体短缺，他们通常无法接受手术或再次移植。最近，有人提出原发性经皮经肝门静脉支架置入术（PTPS）作为PVS的替代且侵入性较小的治疗方法。然而，由于LT术后早期患者进行这些原发性支架置入可能会出现致命并发症，因此有人建议对LT术后1个月发生PVS的患者进行原发性PTPS置入。2009年11月至2015年7月，我院连续38例成年患者接受了LT。其中，6例受者在LT后1个月内发生了PVS。所有6例患者均取得技术成功。LT术后1周内发生PVS的4例患者中有2例取得临床成功，另外2例LT术后PVS>1周的患者也取得临床成功。所有存活患者及其移植物状况良好，支架保持通畅。我们的经验表明，原发性PTPS置入可有效治疗LT后1个月内甚至1周内发生PVS的患者，短期结果可接受。然而，应牢记可能的致命并发症。这些手术的长期结果需要进一步随访。
