关键词: 肝移植, 门静脉, 多普勒超声, 术后并发症

Abstract:

Management of portal vein thrombosis during the perioperative period of orthotopic liver transplantation WU Gang, LIU Yong-feng,CHENG Dong-hua，et al. Department of General Surgery, the First Affiliated Hospital,China Medical University,Shenyang 110001,China Corresponding auther: LIU Yong-feng, E-mial: yfliu@mail.cmu. edu.cn Abstract Objective To analyze the managements of portal vein thrombosis(PVT) during the perioperative period of orthotopic liver transplantation.Methods Between May 1995 to June 2008,194 orthotopic liver transplantation were performed in our institute,of which 24 presented portal vein thrombosis .12 were grade Ⅰ,9 grade Ⅱ,2 grade Ⅲ and 1 grade Ⅳ . The management of PVT depended mainly on its extent.Ligation of the collateral circulation,especially spontaneous or surgical splenorenal shunt,was made as approaches to improve portal flow. Heparin or low-molecule-weight heparin as a prophylactic anticoagulation therapy was maintained during and after operation if prothrombin time is less than eighteensonds. Follow-up Doppler ultrasonography was used daily in the early postoperative period.Results After a follow-up of 6-104 months, overall incidence of portal vein thrombosis was 2.58%(5/194).Surgical thrombectomy and revascularization was carried out in 1 case. Percutanous thrombolysis ,balloon angioplasty, or stent placement via portal vein were performed in 3 cases.No treatment was given in 1 patient without hepatic dysfunction. Mortality related to portal vein thrombosis was 0.Conclusion PVT might be avoid by performing a ideal technique for managing PVT as often as possible,by ligation of portosystemic shunt during surgery, and by postoperative anticoagulation.Close follow-up by Doppler ultrasonography may make a prompt diagnosis and reduce PVT-derived loss of grafts.

Key words: liver transplantation, portal vein, Doppler ultrasonography, postoperative complications