Davidson B R, Gibson M, Dick R, Burroughs A, Rolles K
Department of Surgery, Royal Free Hospital, London, United Kingdom.
Transplantation. 1994 Apr 27;57(8):1174-7. doi: 10.1097/00007890-199404270-00006.
Portal vein thrombosis is often considered a contraindication to orthotopic liver transplantation. We have analyzed the incidence, risk factors, management and outcome of patients with portal vein thrombosis undergoing orthotopic liver transplantation. During the period from October 1988 to October 1992 140 grafts were performed on 132 patients. Fourteen had portal vein thrombosis with either partial (n = 7) or complete (n = 7) occlusion of the portal vein at surgery. Portal vein thrombosis was more common in patients with autoimmune chronic active hepatitis (3/5 vs. 11/127, chi 2 = 13.3, P < 0.001), cryptogenic cirrhosis (4/12 vs. 10/120, chi 2 = 7.2, P < 0.01), or those with tumors (6/22 vs. 10/110, chi 2 = 5.7, P < 0.05). In 13 of the 14 portal inflow was reestablished by flushing, balloon thrombectomy, or passage of a graduated dilator. In one patient complete fibrous obliteration necessitated a portal vein to right gastroepiploic vein anastomosis. On follow-up there have been 6 deaths in this group (6/14 = 43%) from recurrent cancer (n = 1), sepsis (n = 4), and cardiac and renal failure (n = 1). Four of these 6 patients had confirmation of PV patency on imaging. The remaining 8 patients are alive and well (median follow-up 37 months, range 6-53 months). Post-transplant portal vein thrombosis occurred in 3 of the 14 patients (21%) with a portal vein abnormality at surgery and in two of the 118 patients with a normal portal vein (3/14 vs. 2/118, chi 2 = 8.5, P < 0.01). Four of the 5 cases were successfully treated by surgical thrombectomy.
门静脉血栓形成通常被视为原位肝移植的禁忌证。我们分析了接受原位肝移植的门静脉血栓形成患者的发病率、危险因素、治疗方法及预后。1988年10月至1992年10月期间，对132例患者实施了140例肝移植手术。其中14例患者在手术时存在门静脉血栓形成，门静脉部分闭塞（n = 7）或完全闭塞（n = 7）。门静脉血栓形成在自身免疫性慢性活动性肝炎患者中更为常见（3/5 vs. 11/127，χ² = 13.3，P < 0.001）、隐源性肝硬化患者中（4/12 vs. 10/120，χ² = 7.2，P < 0.01）或患有肿瘤的患者中（6/22 vs. 10/110，χ² = 5.7，P < 0.05）。14例患者中有13例通过冲洗、球囊血栓切除术或使用逐渐变细的扩张器使门静脉血流得以重建。1例患者因门静脉完全纤维性闭塞而进行了门静脉至右胃网膜静脉吻合术。随访期间，该组有6例患者死亡（6/14 = 43%），死因包括复发性癌症（n = 1）、脓毒症（n = 4）以及心肾衰竭（n = 1）。这6例患者中有4例经影像学检查证实门静脉通畅。其余8例患者存活且状况良好（中位随访时间37个月，范围6 - 53个月）。14例手术时门静脉异常的患者中有3例（21%）发生了移植后门静脉血栓形成，118例门静脉正常的患者中有2例发生了移植后门静脉血栓形成（3/14 vs. 2/118，χ² = 8.5，P < 0.01）。5例患者中有4例通过手术取栓成功治疗。
