Malassagne B, Soubrane O, Dousset B, Legmann P, Houssin D
Clinique Chirurgicale, Hôpital Cochin, Paris.
HPB Surg. 1998;10(6):357-63; discussion 363-4. doi: 10.1155/1998/81832.
This study reports our experience of 8 cases of extrahepatic portal hypertension after 273 orthotopic liver transplantations in 244 adult patients over a 10-year period. The main clinical feature was ascites, and the life-threatening complication was variceal bleeding. Extrahepatic portal hypertension was caused by portal vein stenosis in 6 patients, and left-sided portal hypertension in 2 patients after inadventent ligation of portal venous tributaries or portasystemic shunts. All patients with portal vein stenosis had complete relief of portal hypertension after percutaneous transhepatic venoplasty (n = 4) or surgical reconstruction (n = 2), after a median follow-up of 33 (range: 6-62) months. Of the 2 patients with left-sided portal hypertension, one died after splenectomy and one rebled 6 months after left colectomy. This study suggests that extrahepatic portal hypertension is a series complication after liver transplantation that could be prevented by meticulous portal anastomosis and closure of portal tributaries or portasystemic shunts to improve the portal venous flow. However, any ligation has to be performed under ultrasound guidance to avoid inadventent venous ligations.
本研究报告了我们在10年期间对244例成年患者进行273例原位肝移植后8例肝外门静脉高压的经验。主要临床特征为腹水，危及生命的并发症为曲张静脉出血。6例患者的肝外门静脉高压由门静脉狭窄引起，2例患者在意外结扎门静脉分支或门体分流术后出现左侧门静脉高压。所有门静脉狭窄患者在经皮经肝静脉成形术（n = 4）或手术重建（n = 2）后，门静脉高压均完全缓解，中位随访时间为33个月（范围：6 - 62个月）。2例左侧门静脉高压患者中，1例在脾切除术后死亡，1例在左半结肠切除术后6个月再次出血。本研究表明，肝外门静脉高压是肝移植后的一系列并发症，可通过细致的门静脉吻合以及关闭门静脉分支或门体分流来改善门静脉血流以预防。然而，任何结扎都必须在超声引导下进行，以避免意外静脉结扎。
