肝移植早期动脉血流障碍的急诊介入血管内治疗

B. B. Gegenava, S. A. Kurnosov, Y. Moysyuk, N. Vetsheva, A. Ammosov
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摘要

介绍。肝移植被认为是终末期肝病患者最有效的治疗方法。x线血管内介入治疗移植后血管并发症效果良好。时机、适应症和治疗方法的选择需要明确。目的评价急诊x线血管内介入治疗肝移植术后早期动脉并发症的安全性和有效性。材料和方法。从2016年10月到2021年7月,共进行了88例肝移植手术。75例从死后供体获得移植物,13例从活体供体(肝右叶)获得移植物。动脉并发症10例:肝动脉血栓形成7例(8.0%),收缩3例(3.4%);4例因血栓形成再次移植。本研究纳入6例患者,年龄27 ~ 51岁,男4例,女2例。术后早期(0-14天),根据实验室参数、超声多普勒和造影剂计算机断层扫描,发现移植物动脉血液供应受损,因此患者接受了急诊x线图像引导下的血管内介入手术。所有6例患者均恢复了肝移植物充足的动脉血液供应。在撰写本文时,移植物功能和肝动脉通畅在随访6、11、12、22个月(2例患者)和26个月(中位随访17个月)中得以保留。4例患者出现胆道并发症,需要手术矫正。x线图像引导血管内介入治疗肝移植术后动脉并发症是有效且相对安全的。为了防止胆道并发症的发生,应尽量缩短移植动脉缺血的时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Emergency interventional endovascular treatment for early disorder of arterial blood flow in the liver graft
Introduction. Liver transplantation is considered the most effective treatment for patients with end-stage liver disease. X-ray endovascular interventions show good results in the treatment of vascular complications after transplantation. The timing, indications and choice of treatment methods require clarification.Objective. To evaluate the safety and efficacy of emergency X-ray endovascular interventions for arterial complications in the early period after liver transplantation.Material and methods. In the period from October 2016 by July 2021, 88 liver transplants were performed. The graft was obtained from a posthumous donor in 75 cases, and from a living donor (right lobe of the liver) in 13 cases. Arterial complications were registered in 10 cases: thrombosis of the hepatic artery in 7 (8.0%), constriction in 3 (3.4%); 4 patients underwent retransplantation due to thrombosis. This analysis included 6 patients aged 27 to 51 years, including 4 men and 2 women. In the early postoperative period (0–14 days), according to laboratory parameters, ultrasound Doppler, and computed tomography with a contrast agent, an impairment of the arterial blood supply of the graft was revealed, for which the patients underwent emergency X-ray image-guided surgical endovascular interventions.Results. Restoration of adequate arterial blood supply to the liver graft was achieved in all six patients. At the time of this writing, the graft function and patency of the hepatic artery were preserved at follow-up periods of 6, 11, 12, 22 (in two patients), and 26 months with a median of 17 months. Four patients developed biliary complications that required surgical correction.Conclusion. X-ray image-guided endovascular interventions can be considered effective and relatively safe in the treatment of patients with arterial complications after liver transplantation. The period of graft arterial ischemia should be minimized as much as possible in order to prevent biliary complications.
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