Seu P, Shackleton C R, Shaked A, Imagawa D K, Olthoff K M, Rudich S R, Kinkhabwala M, Busuttil R W
Dumont-UCLA Liver Transplant Program, UCLA School of Medicine, USA.
Arch Surg. 1996 Aug;131(8):840-4; discussion 844-5. doi: 10.1001/archsurg.1996.01430200050009.
To analyze the impact of preexisting portal vein thrombosis (PVT) on the operative management and outcome of liver transplantation.
Retrospective review of 1423 patients who received transplants over 11 years.
Tertiary referral center.
Seventy patients who underwent liver transplantation who had preexisting PVT.
Portal vein thromboendovenectomy, vein grafting, or use of portal collateral veins for inflow during liver transplantation.
Postoperative PVT, intraoperative transfusion, retransplantation rate, 30-day and 1-year actuarial survival rates.
Operative management consisted of thromboendovenectomy in 61 cases, vein graft to the superior mesenteric vein in 6 cases, and vein graft to other mesenteric veins in 3 cases. The incidence of posttransplant PVT was 3% (n = 2). The mean +/- SD transfusion requirement was 23 +/- 18 U. The 1-year actuarial survival rate was 74% but improved from 66% in the first 35 cases to 82% in the latter 35 cases.
Thromboendovenectomy is the procedure of choice for PVT. Results of liver transplantation in patients with PVT improve significantly with experience gained and are equivalent to results in patients without PVT.
分析门静脉血栓形成（PVT）对肝移植手术管理及预后的影响。
对11年间接受移植的1423例患者进行回顾性研究。
三级转诊中心。
70例行肝移植且术前存在PVT的患者。
门静脉血栓内膜切除术、静脉移植术，或在肝移植期间使用门静脉侧支静脉进行血流供应。
术后PVT、术中输血情况、再次移植率、30天和1年精算生存率。
手术管理包括61例血栓内膜切除术、6例肠系膜上静脉静脉移植术、3例其他肠系膜静脉静脉移植术。移植后PVT发生率为3%（n = 2）。平均±标准差输血需求量为23±18单位。1年精算生存率为74%，但从前35例的66%提高到后35例的82%。
血栓内膜切除术是PVT的首选手术方式。随着经验的积累，PVT患者肝移植的结果显著改善，且与无PVT患者的结果相当。
