Kawano Youichi, Murata Satoru, Taniai Nobuhiko, Yoshioka Masato, Hirakata Atsushi, Mizuguchi Yoshiaki, Shimizu Tetsuya, Kanda Tomohiro, Ueda Junji, Takada Hideyuki, Yoshida Hiroshi, Akimaru Koho, Onozawa Shiro, Kumita Shinichirou, Uchida Eiji
Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School.
J Nippon Med Sch. 2016;83(5):206-210. doi: 10.1272/jnms.83.206.
Portal vein thrombosis (PVT) is a rare complication of liver transplantation which can lead to graft failure and patient death. Treatment can be difficult, especially in cases of PVT from the intrahepatic portal vein to the proximal jejunal veins. A 55-year-old woman had undergone living-donor liver transplantation with splenectomy for end-stage liver cirrhosis due to hepatitis C with hepatocellular carcinoma. Ten months after transplantation, massive ascites and slight abdominal pain developed, and computed tomography revealed a PVT between the intrahepatic portal vein and the superior mesenteric vein. Repeated interventional radiology procedures were used in combination with thrombolysis, thrombectomy, and metallic stent replacement to obtain favorable portal flow to the graft. Five years after being treated, the patient is well, with favorable portal flow having been confirmed. In conclusion, repeated and assiduous interventional radiological treatment combined with thrombolytic therapy, thrombectomy, and metallic stent replacement could be important for severe PVT.
门静脉血栓形成（PVT）是肝移植中一种罕见的并发症，可导致移植肝失功和患者死亡。治疗可能很困难，尤其是对于从肝内门静脉到空肠近端静脉的PVT病例。一名55岁女性因丙型肝炎合并肝细胞癌导致终末期肝硬化，接受了活体肝移植及脾切除术。移植术后10个月，出现大量腹水和轻微腹痛，计算机断层扫描显示肝内门静脉与肠系膜上静脉之间存在PVT。反复采用介入放射学方法，联合溶栓、血栓切除术和金属支架置换，以获得移植肝良好的门静脉血流。治疗5年后，患者情况良好，已证实门静脉血流良好。总之，反复、细致的介入放射学治疗联合溶栓治疗、血栓切除术和金属支架置换对于严重PVT可能很重要。
