目的

评价肝移植术后门静脉狭窄或伴血栓形成者内支架植入治疗的疗效。

方法

回顾性分析2004年11月—2012年8月，31例原位肝移植术后门静脉狭窄且成功植入门静脉支架患者的临床资料。所有患者行经皮肝穿刺门静脉支架植入治疗，对合并门静脉血栓者行溶栓治疗，对侧支曲张明显或分流严重者行栓塞治疗。术后定期随访患者临床症状及影像学资料，了解支架及并发症发生情况。

结果

31例患者共植入支架39枚，4例行溶栓治疗，5例给予侧支栓塞治疗，术后门静脉血流通畅。2例门脉海绵样变者成功开通门静脉且植入支架。随访期6～99个月，各随访时间支架累积通畅率均为100%。1例合并门静脉血栓者术后17个月出现脾静脉血栓再形成。术后严重并发症为胸膜腔出血1例（1/31，3.23%）；支架对侧门静脉分支血流缓慢1例（1/31，3.23%）。

结论

门静脉支架植入治疗是肝移植术后门静脉狭窄的有效方法，并发症发生率低。但合并门静脉血栓者，术后远期可能出现血栓再形成，对术后严重并发症的处理需慎重。

Objective

To evaluate the efficacy of the stent implantation in treatment of portal vein stenosis or thrombosis after liver transplantation.

Methods

From November 2004 to August 2012，31 patients with portal vein stenosis after liver transplantation were referred for angiographic analysis and stent placement treatment successfully.After percutaneous transheptic balloon angioplasty，stents were deployed.Thrombolytic therapy for patients with portal vein thrombosis.Embolization was performed in patients with varices or portal vein flow changes.The therapeutic results were monitored by the follow-up on clinical symptoms and imaging examinationsin in order to know about the stent and complications.

Results

Thirty-nine stents were deployed subsequently.Four patients were given thrombolytic therapy，and 5 patients were given collateral embolization included.All the portal vein recanalized and the symptoms were relieved.Besides，2 patients with portal vein stenosis and cavernous transformation were given stent placement successfully.Portal vein patency was all maintained in 29 patients for 6-99 months.The cumulative patency rate was 100%.In the follow-up study，the splenic vein thrombosis raised again in one case of portal vein thrombosis（PVT）after 17 months therapy.The short-time severe complication related to interventional therapy was thoracic cavity hemorrhage in 1 cases（1/31，3.23%）；and the long-term complication was the blood flown down in the other branch of portal vein in 1 cases（1/31，3.23%）.

Conclusions

Interventional therapy is an effective method for the treatment of portal vein stenosis after liver transplantation and has low stent restenosis rate.For the patient with PVT，it still has the risk of thrombosis again in the long-term study.And we should be vigilant for possible complications.