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目的:探讨成人肝移植术后急性肝动脉血栓(HAT)介入治疗的安全性及疗效。方法:回顾性分析2012年1月-2015年2月我院成人肝移植术后急性HAT患者7例。7例均因肝酶学异常或早期床旁超声监测未见明显肝动脉血流信号而行急诊血管造影检查确诊。6例介入治疗成功。观察治疗前后相关实验室指标及有无手术并发症,并进行随访。结果:所有患者均表现为肝固有动脉完全阻塞。导管内溶栓(IAT)后,6例血管成功开通,其中2例行经皮腔血管成形术(PTA)联合内支架置入(ES)治疗。1例溶栓治疗失败,后行外科血管重建术。术后丙氨酸氨基转移酶(ALT)和总胆红素(TBil)明显下降(P<0.001)。随访2-12个月,未出现明显手术相关并发症。结论:介入治疗作为一种微创、安全及有效的治疗手段,可作为一线治疗方案应用于肝移植术后HAT的治疗,近、中期疗效显著,远期疗效有待随访观察。
Objective: To investigate the safety and efficacy of interventional treatment of acute hepatic artery thrombosis (HAT) after liver transplantation in adults. Methods: A retrospective analysis of 7 patients with acute HAT after adult liver transplantation in our hospital from January 2012 to February 2015 was retrospectively analyzed. 7 cases were diagnosed by emergency angiography because of abnormal liver enzymes or early bedside ultrasound monitoring showed no significant hepatic artery blood flow signals. 6 cases of successful intervention. Observed before and after treatment related laboratory indicators and the presence of surgical complications, and follow-up. Results: All patients showed complete obstruction of the hepatic artery. After intraductal thrombolysis (IAT), 6 vessels were successfully opened, and 2 received percutaneous transluminal angioplasty (PTA) combined with stent placement (ES). One patient failed thrombolysis and then underwent surgical revascularization. Postoperative alanine aminotransferase (ALT) and total bilirubin (TBil) decreased significantly (P <0.001). Follow-up 2-12 months, no significant surgical complications. Conclusion: Interventional therapy, as a minimally invasive, safe and effective treatment, can be used as a first-line treatment for the treatment of HAT after liver transplantation. The curative effect is obvious in the near and the middle stages, and the long-term efficacy remains to be followed up.