Moreno González E, García García I, Gómez Sanz R, González-Pinto I, Loinaz Segurola C, Jiménez Romero C
General and Digestive Surgery, Hospital Universitario Doce de Octubre, Madrid, Spain.
Br J Surg. 1993 Jan;80(1):81-5. doi: 10.1002/bjs.1800800127.
Fourteen cases are presented of preoperative portal vein thrombosis complicating orthotopic liver transplantation from an experience of 195 transplants carried out between April 1986 and April 1991. In four patients who suffered rethrombosis of the portal vein, the mortality rate was 100 per cent from various causes. Overall there were six deaths; two of those who died had a patent portal vein at death. Three patients underwent retransplantation: one for primary non-function, two for rejection. It is concluded that: (1) portal vein thrombosis should not represent an absolute contraindication to liver transplantation; (2) preoperative screening of prospective transplant recipients for portal thrombosis should be routine; (3) postoperative anticoagulation therapy and periodic Doppler ultrasonographic assessment of portal vein flow are important elements of post-transplant management; and (4) with thrombectomy and portal vein resection an end-to-end portal anastomosis may be performed with good results.
本文报告了1986年4月至1991年4月间进行的195例原位肝移植中，术前门静脉血栓形成的14个病例。4例门静脉再血栓形成的患者，因各种原因死亡率为100%。总体有6例死亡；其中2例死亡时门静脉通畅。3例患者接受了再次移植：1例因原发性无功能，2例因排斥反应。结论如下：（1）门静脉血栓形成不应成为肝移植的绝对禁忌证；（2）对潜在移植受者进行术前门静脉血栓筛查应成为常规；（3）术后抗凝治疗及定期用多普勒超声评估门静脉血流是移植后管理的重要环节；（4）通过血栓切除术和门静脉切除可进行门静脉端端吻合，效果良好。
