Chardot C, Herrera J M, Debray D, Branchereau S, De Dreuzy O, Devictor D, Dartayet B, Norwood P, Lambert T, Pariente D, Gauthier F, Valayer J
Paediatric Surgery Unit, Bicêtre Hospital, France.
Liver Transpl Surg. 1997 Jul;3(4):351-8. doi: 10.1002/lt.500030401.
The objective of this report is to review portal complications (PC) after pediatric liver transplantation (LT) for biliary atresia (BA) in the Bicêtre surgical series. From January 1, 1988, to February 28, 1995, 96 children with BA underwent 115 LTs Portal anastomosis was done on either the recipient portal vein (n = 85) or superior mesenteric vein (n = 11). No antiaggregative agents were administered postoperatively. Median follow-up was 50 months (range, 12 to 97). Nineteen PC (16.5%) occurred in 17 recipients: 16 portal thrombosis (PT) and 3 portal stenosis (PS). Fifteen instances of early PT occurred between days 0 and 17 (median, day 2). Emergency thrombectomy was performed in 9 cases (successful in 5). Three children underwent a secondary portosystemic shunt (successful in 2). Three PS were cured by either surgery or balloon dilatation. Four children died, 3 are alive with portal hypertension (PHT), and 10 are alive without PHT. Three-year patient actuarial survival is 82.4% in PC cases and 82% in others (NS). Significant risk factors of PC are young age and weight at the time of LT, small portal vein, and emergency LT. Analysis of our own results and review of the literature suggest that prevention of PC depends primarily on appropriate surgical technique. Reduction of postoperative hypercoagulability may also play an important role: a meta-analysis of 1,257 published pediatric LT show an overall risk of PT of 2.2% in teams using aspirin with or without dipyridamole compared with 7.8% when no antiaggregative agents are given (P = .0001).
本报告旨在回顾比塞特尔外科系列中儿童肝移植（LT）治疗胆道闭锁（BA）后的门静脉并发症（PC）。从1988年1月1日至1995年2月28日，96例BA患儿接受了115次肝移植。门静脉吻合在受体门静脉（n = 85）或肠系膜上静脉（n = 11）上进行。术后未使用抗聚集剂。中位随访时间为50个月（范围12至97个月）。17例受者发生了19例PC（16.5%）：16例门静脉血栓形成（PT）和3例门静脉狭窄（PS）。15例早期PT发生在术后0至17天（中位时间为第2天）。9例进行了急诊血栓切除术（5例成功）。3例患儿接受了二次门体分流术（2例成功）。3例PS通过手术或球囊扩张治愈。4例患儿死亡，3例存活伴有门静脉高压（PHT），10例存活无PHT。PC病例的3年患者精算生存率为82.4%，其他病例为82%（无显著性差异）。PC的显著危险因素包括肝移植时年龄小、体重轻、门静脉细小和急诊肝移植。对我们自己的结果分析和文献回顾表明，PC的预防主要取决于适当的手术技术。降低术后高凝状态也可能起重要作用：对1257篇已发表的儿童肝移植文献的荟萃分析显示，使用阿司匹林加或不加双嘧达莫的团队中PT的总体风险为2.2%，而未使用抗聚集剂时为7.8%（P = .0001）。
