Advances in Clinical Medicine
Vol.
14
No.
04
(
2024
), Article ID:
84780
,
7
pages
10.12677/acm.2024.1441154
肝移植术后血管相关并发症的研究进展
加依达尔·胡玛尔汗1,温浩1,2*
1新疆医科大学第一附属医院消化血管外科中心肝胆包虫病外科,新疆 乌鲁木齐
2新疆医科大学,省部共建中亚高发病成因与防治国家重点实验室,新疆 乌鲁木齐
收稿日期:2024年3月19日;录用日期:2024年4月13日;发布日期:2024年4月18日
摘要
肝移植术后血管相关并发症是严重威胁患者生命健康的术后并发症,主要包括肝动脉、门静脉、流出道以及人工血管并发症等。约有7%~13%的肝移植患者术后可能发生血管并发症,进而出现肝脏移植物功能障碍,最终导致患者死亡。早期发现并诊断病变,通过介入治疗等方案有助于及时挽救患者生命。尽管外科技术的发展降低了该类并发症发生率,但一旦发生仍十分凶险,这对临床医生是极大的挑战。
关键词
肝移植,血管并发症,动脉,静脉,人工血管
Research Progress of Vascular Complications after Liver Transplantation
Jiayidaer∙Humaerhan1, Hao Wen1,2*
1Department of Hepatobiliary & Hydatid Disease, Digestive & Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang
2State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi Xinjiang
Received: Mar. 19th, 2024; accepted: Apr. 13th, 2024; published: Apr. 18th, 2024
ABSTRACT
Vascular complications after liver transplantation are serious complications that threaten patients’ life and health, mainly including hepatic artery, portal vein, outflow tract and artificial vascular complications. Approximately 7%~13% of liver transplant patients may develop vascular complications after surgery, which can lead to liver graft dysfunction and ultimately death. Early detection and diagnosis of lesions through interventional therapy and other programs are helpful to save patients’ lives in time. Although the development of surgical techniques has reduced the incidence of such complications, once they occur, they are still very dangerous, which is a great challenge for clinicians.
Keywords:Liver Transplantation, Vascular Complications, Artery, Vein, Artificial Vascular
Copyright © 2024 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
http://creativecommons.org/licenses/by/4.0/
1. 引言
血管并发症是肝移植术后最严重并发症之一,是导致移植肝功能衰竭甚至患者死亡的重要原因,主要包括肝动脉并发症、门静脉并发症、流出道并发症以及人工血管相关并发症等。其中,肝动脉并发症包括肝动脉血栓形成、肝动脉狭窄等;门静脉并发症包括门静脉狭窄、门静脉血栓形成等;流出道并发症主要包括肝静脉和下腔静脉梗阻,主要是由血管吻合不当、血管内膜损伤等原因所致。
这些并发症的发生率随着外科技术的发展而逐渐下降,但一旦发生,后果十分凶险,可能导致腹水、感染等临床表现,重则影响肝脏血液回流,加剧肝脏移植物功能衰竭甚至患者的死亡。为了预防和减少血管并发症的发生,多普勒超声被广泛应用于肝移植术后的监测。它能敏感地监测肝血管的一切变化,及时发现血管病变,以早期诊断血管并发症,挽救移植肝的功能。
2. 肝动脉并发症
肝移植术后肝动脉并发症与肝动脉本身的病变以及吻合技术有关,血管条件方面主要原因包括供受体动脉内径差异、术中输血、感染、受体高凝状态、免疫排斥反应、术后动脉血流缓慢等。手术操作方面主要包括血管吻合口狭窄、多个吻合口、过长扭曲成角、无肝期时间过长、血管内膜损伤等 [1] [2] [3] 。过去的观点认为手术因素是导致早期肝动脉血栓形成的主要原因,这主要是因为在肝移植手术过程中,对肝动脉的操作和处理相对复杂,容易出现技术上的困难和失误。随着腹腔外科和显微外科技术的不断进步,手术操作精细化,手术技巧也不断提高,这使得手术因素引起的早期肝动脉血栓形成的发生率明显降低 [4] 。
肝动脉在肝移植术后胆道系统的供血中起着至关重要的作用,它是胆道系统的主要供血来源,确保了胆道系统的正常功能和健康 [5] 。当肝动脉出现并发症时,会直接影响到胆道系统的血液供应,它可能导致胆管壁的坏死和功能障碍,进一步增加了缺血性胆道并发症等发生的风险 [6] 。在极端情况下,胆道系统的严重并发症可能导致肝脏移植物功能衰竭,甚至需要重新进行肝移植手术。
目前,针对肝动脉并发症的治疗方案主要包括血管介入治疗和外科手术两种 [7] 。血管介入治疗无法解决问题或病情较为复杂时,外科手术是必要选择,主要包括切开取栓、血管重建和二次肝移植。
2.1. 肝动脉血栓(Hepatic Artery Thrombosis, HAT)
HAT肝移植术后一个严重且常见的并发症,其对移植肝的功能和患者的生存构成了重大威胁 [8] [9] 。HAT根据其发生时间分为早期型和晚期型 [10] ,其中早期HAT尤为严重,特别是在术后1周内的病例,这时候的治疗效果往往不尽如人意,使移植肝功能受到威胁,患者甚至面临再次肝移植的风险 [11] 。早期HAT的临床症状并不明显,但实验室检查会提示明显异常,如果伴随感染,患者还可能出现败血症和感染性休克等严重的并发症 [12] 。相比之下,晚期HAT有时可能仅表现为轻度的肝功能异常甚至无明显异常。
2.2. 肝动脉狭窄(Hepatic Artery Stenosis, HAS)
HAS也是肝移植后常见血管并发症之一,其发生时间可以从术后数日到数年不等。根据动脉吻合口狭窄口径可分为三个等级:轻度(<50%)、中度(50%~75%)、重度(>75%) [13] 。HAS对移植肝的影响程度有很大的差异,可能会导致胆道缺血性病变,严重时甚至可能导致肝坏死。然而,有些情况下HAS可能仅表现为轻微的肝功能损害,甚至可能没有明显的临床症状。尽管HAS的严重程度和临床表现各异,但如果不进行及时处理,有研究表明,6个月内进展为肝动脉栓塞的可能性高达65% [14] 。因此,对HAS的早期诊断和治疗至关重要。
2.3. 肝动脉假性动脉瘤(Hepatic Artery Pseudoaneurysm, HAP)
HAP是一种相对罕见的肝移植术后并发症,虽然其发病率不高,但其潜在的严重性不容忽视。根据动脉瘤发生位置的不同,HAP可分为肝内型和肝外型。其中以肝外型为多数,约占69.0%~100%,主要与血管医源性损伤、血管吻合技巧、局部真菌感染等因素相关 [15] [16] ,对于这类动脉瘤,手术切除可能是一个有效的治疗方法。对于肝功能正常的HAP,可以暂不予处理,但需定期复查,密切关注病情变化。对于有症状的患者或动脉瘤有增大趋势的情况,血管介入治疗是可行的选择,通常可以取得满意的效果。
2.4. 脾动脉盗血综合征(Splenic Arterial Steal Syndrome, SASS)
SASS是一种严重的并发症,它主要是由于脾动脉过粗,与肝动脉竞争来自腹腔干的血流,导致肝总动脉血流低灌注和肝组织缺血缺氧,肝脏和胆管缺血性损伤的综合征 [17] 。这种综合征在肝移植术后可能导致胆道缺血损伤、肝功能不全等严重后果 [18] 。有研究认为,SASS可能与动脉重建过程中的操作不当导致吻合口狭窄、门静脉高压或脾功能亢进导致门静脉血流量增多 [19] 、以及脾动脉直径增粗使得流入脾脏的血流增多等有关。
肝动脉相对罕见的并发症还有肝动脉破裂出血、弓状韧带综合征等 [20] 。肝动脉并发症一旦发生,其处理非常棘手。早期防诊治是提高患者生存率及预后的关键。
3. 门静脉并发症
门静脉相关并发症在肝移植术后不常见,主要发生于门静脉吻合口上,但其预后较差,严重情况下可能导致肝功能衰竭甚至患者死亡。因此,对门静脉狭窄的早期识别和干预治疗至关重要。门静脉相关并发症主要为门静脉血栓(portal vein thrombosis, PVT)和门静脉狭窄(portal vein stenosis, PVS),其高危因素主要包括血管吻合技术、术前已合并门静脉病变、受体高凝状态、供受者门静脉口径差异大、既往断流/分流手术史以及免疫排斥反应等 [21] [22] 。对于门静脉相关并发症的治疗,具体的方案应根据患者的具体情况和狭窄的严重程度来制定。主要的治疗方法包括全身药物抗凝治疗、血管内介入治疗和外科治疗等。在治疗过程中,应密切关注患者的肝功能和门静脉血流情况,及时调整治疗方案,以确保患者的安全和移植肝的功能。
3.1. PVT
PVT在肝移植术后的发生率约为2%,其形成与多种因素有关。术中门静脉的排列不良或残留段过长可能导致血流动力学改变,增加血栓形成的风险。如果患者在术前已经存在PVT,那么术后血栓的风险也会相应增加。此外,高凝状态也是一个重要的影响因素,可能与手术应激、输血、使用止血药物等多种原因有关。PVT不仅会影响移植肝的功能,还可能导致门脉高压,进一步增加肝功能衰竭和患者死亡的风险。PVT的药物治疗主要包括抗凝治疗和溶栓治疗,旨在促进血栓的溶解和防止血栓的进一步形成;介入治疗如机械取栓和导管溶栓等,可以直接作用于血栓,提高治疗效果。
3.2. PVS
导致PVS的原因有多种,其中包括门静脉供体段过长、迂曲成角或供-受体血管口径不匹配等手术技巧问题,这些因素可能导致术后门静脉出现不同程度的狭窄。在诊断PVS时,应注意与吻合口血管的生理性狭窄进行鉴别,血管吻合口较明显的管径变化可能导致血流动力学上的狭窄表现,这可能会影响肝脏的正常生理功能。对于因手术技巧导致的机械性狭窄,通常需要进行局部扩张或二次手术来修复。而因吻合口水肿所致的一过性狭窄,在水肿消退后,门静脉狭窄的情况可能会逐渐好转 [23] 。
4. 流出道并发症
肝移植术后流出道并发症主要表现为流出道梗阻,一般发生于下腔静脉及肝静脉。下腔静脉及肝静脉并发症包括血栓形成和管腔狭窄,此类并发症的发生率为4.5%~15.1% [24] [25] [26] 。流出道梗阻按发生时间的早晚,可分为早发(急性)型和晚发(慢性)型两种形式。早发型多发生在术后一个月之内,主要与血管吻合口狭窄、吻合口过于紧密、肝静脉扭转以及供受体体型差异等有关;晚发型HVOO则发生在术后一个月之后,其主要与血管内膜增生和吻合口纤维化形成疤痕等问题有关。有研究报道,肝脏移植物旋转引起的流出道梗阻,更易发生于左半肝 [27] 。主要表现为不明原因的腹腔积液、肝脾肿大、低蛋白血症及转氨酶升高等布–加综合征表现 [28] [29] [30] 。
术后发生流出道梗阻的患者主要的治疗方法包括药物抗凝治疗、血管内介入治疗及手术治疗。对于术后早期发现的患者,首选手术治疗,辅以抗凝治疗;当发生严重的肝功能衰竭时,需要再次进行肝移植手术;对于术后部分血栓形成的患者,可全身抗凝治疗或口服抗凝药物 [31] ;对于术后晚期发现的患者可通过介入治疗如球囊扩张血管成形术或支架植入术来改善症状 [32] 。
5. 人工血管并发症
5.1. 梗阻及狭窄
吻合口狭窄或血栓形成是各类材料都有可能发生的并发症 [33] ,常导致肝脏充血和最终的移植失败 [34] 。在肝移植术后血管并发症中,无论使用何种修补材料进行血管重建,都存在发生血管狭窄或梗阻的风险,这种狭窄通常是由内皮细胞内膜增生和血栓形成导致的 [35] 。如果重建的血管尺寸过小,可能导致血液流动形成湍流,从而增加血栓形成和管腔闭塞的风险 [36] 。及时做出准确的诊断对于其有效治疗和改善患者预后至关重要。有报道称,越早诊断血管狭窄及梗阻,介入性血管重建的疗效和成功率就越高 [37] 。因此,在肝移植术后应密切关注患者的临床症状和肝功能变化,一旦发现血管狭窄或梗阻的迹象,应立即进行诊断和治疗。
5.2. 感染
细菌感染是人工血管用于肝移植术后可能发生的罕见并发症 [38] 。作为非生物材料,人工血管在植入人体后可能成为细菌定植的位点,为微生物提供了一个生长和繁殖的环境。特别是在血管移植物的吻合区,由于血液流动的改变和可能的组织损伤,细菌更容易在这些区域定植和繁殖。有研究报道,表皮葡萄球菌在血管吻合区感染的发生率约为1%~6% [39] ,这种感染可能导致移植物功能受损、手术失败甚至患者死亡。此外,人工血管特有的节点–原纤维晶格结构特性也会阻碍内皮细胞的生长,从而延迟血管内皮化的过程,增加术后感染的风险 [40] 。
5.3. 侵袭周围组织
在肝移植手术中,人工血管有侵蚀到周围组织如十二指肠、胃等的可能 [41] [42] 。其作为异物,诱导了体内的炎症反应,这种炎症反应促进了血管与周围脏器组织的粘连 [43] 。当人工血管与周围组织接触时,由于其坚韧的质地,可能会引起摩擦和粘连,导致血管逐渐侵蚀到周围组织 [39] 。为了减少人工血管侵蚀到周围组织的风险,术中可以采用网膜等组织将胃肠道与人工血管之间进行填塞隔离,这种隔离措施可以防止胃肠道与人工血管之间的直接接触,从而减少血管移植物与周围组织之间的摩擦和粘连 [38] 。
6. 总结与展望
肝移植术后血管相关并发症的发生是一个复杂且需要谨慎处理的问题。对于有发生血管并发症风险的患者,应尽早在术后进行长期抗凝治疗;其余患者可根据手术方案及术后病情的监测情况进行判断。在选择治疗方案时,也需要根据患者的具体情况进行综合考虑,如患者的血管并发症类型、发生时间、全身状况、是否存在其他合并症、肝功能的损害程度以及这些症状是否可逆等,治疗方案的选择应遵循多样化和个体化的原则,以确保患者获得最佳的治疗效果。
及时准确的选择性血管造影是诊断血管并发症的重要手段,它不仅可以清晰地显示病灶的发生位置,还可以进一步进行介入治疗操作。对于B超等技术手段不能确诊时的患者,应及时进行选择性血管造影以防病情发展或变化。
总之,肝移植术后血管并发症的预防和早期诊断是提高移植成功率的关键。B超等监测手段的应用以及及时的诊断和治疗对于减少并发症的发生和保护移植肝的功能具有重要意义。同时,对于已经出现血管并发症的患者,应该根据具体情况采取相应的治疗措施,以最大程度地保护患者的生命健康。
文章引用
加依达尔·胡玛尔汗,温 浩. 肝移植术后血管相关并发症的研究进展
Research Progress of Vascular Complications after Liver Transplantation[J]. 临床医学进展, 2024, 14(04): 1263-1269. https://doi.org/10.12677/acm.2024.1441154
参考文献
- 1. Pérez-Saborido, B., Pacheco-Sánchez, D., Barrera-Rebollo, A., et al. (2011) Incidence, Management, and Results of Vascular Complications after Liver Transplantation. Transplantation Proceedings, 43, 749-750. https://doi.org/10.1016/j.transproceed.2011.01.104
- 2. Duffy, J.P., Hong, J.C., Farmer, D.G., et al. (2009) Vascular Complications of Orthotopic Liver Transplantation: Experience in More than 4,200 Patients. Journal of the American College of Surgeons, 208, 896-903. https://doi.org/10.1016/j.jamcollsurg.2008.12.032
- 3. Porrett, P.M., Hsu, J. and Shaked, A. (2009) Late Surgical Complications Following Liver Transplantation. Liver Transplantation: Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 15, S12-S18. https://doi.org/10.1002/lt.21893
- 4. Piscaglia, F., Vivarelli, M., La Barba, G., et al. (2007) Analysis of Risk Factors for Early Hepatic Artery Thrombosis after Liver Transplantation. Possible Contribution of Reperfusion in the Early Morning. Digestive and Liver Disease: Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 39, 52-59. https://doi.org/10.1016/j.dld.2006.08.004
- 5. Feng, M.X., Zhang, J.X., Wan, P., et al. (2020) Hepatic Artery Reconstruction in Pediatric Liver Transplantation: Experience from a Single Group. Hepatobiliary & Pancreatic Diseases International: HBPD INT, 19, 307-310. https://doi.org/10.1016/j.hbpd.2020.06.014
- 6. Bekker, J., Ploem, S. and De Jong, K.P. (2009) Early Hepatic Artery Thrombosis after Liver Transplantation: A Systematic Review of the Incidence, Outcome and Risk Factors. American Journal of Transplantation: Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 9, 746-757. https://doi.org/10.1111/j.1600-6143.2008.02541.x
- 7. Balci, D. and Ahn, C.S. (2019) Hepatic Artery Reconstruction in Living Donor Liver Transplantation. Current Opinion in Organ Transplantation, 24, 631-636. https://doi.org/10.1097/MOT.0000000000000697
- 8. Kutluturk, K., Sahin, T.T., Karakas, S., et al. (2019) Early Hepatic Artery Thrombosis after Pediatric Living Donor Liver Transplantation. Transplantation Proceedings, 51, 1162-1168. https://doi.org/10.1016/j.transproceed.2019.01.104
- 9. Pareja, E., Cortes, M., Navarro, R., et al. (2010) Vascular Complications after Orthotopic Liver Transplantation: Hepatic Artery Thrombosis. Transplantation Proceedings, 42, 2970-2972. https://doi.org/10.1016/j.transproceed.2010.07.063
- 10. Lee, M., Agostini-Vulaj, D. and Gonzalez, R.S. (2019) Evaluation of Histologic Changes in the Livers of Patients with Early and Late Hepatic Artery Thrombosis. Human Pathology, 90, 8-13. https://doi.org/10.1016/j.humpath.2019.04.019
- 11. Castiñeiras, M.B., et al. (2022) Hepatic Artery Thrombosis after Orthotopic Liver Transplant: Experience in the Last 10 Years. Transplantation Proceedings, 54, 51-53. https://doi.org/10.1016/j.transproceed.2021.11.006
- 12. Grodzicki, M., Anysz-Grodzicka, A., Remiszewski, P., et al. (2011) Treatment of Early Hepatic Artery Thrombosis after Liver Transplantation. Transplantation Proceedings, 43, 3039-3042. https://doi.org/10.1016/j.transproceed.2011.08.028
- 13. Rinaldi, P., Inchingolo, R., Giuliani, M., et al. (2012) Hepatic Artery Stenosis in Liver Transplantation: Imaging and Interventional Treatment. European Journal of Radiology, 81, 1110-1115. https://doi.org/10.1016/j.ejrad.2011.02.055
- 14. Hamby, B.A., Ramirez, D.E., Loss, G.E., et al. (2013) Endovascular Treatment of Hepatic Artery Stenosis after Liver Transplantation. Journal of Vascular Surgery, 57, 1067-1072. https://doi.org/10.1016/j.jvs.2012.10.086
- 15. Ma, L., Chen, K., Lu, Q., et al. (2016) Case Report of Hepatic Artery Dissection Secondary to Hepatic Artery Pseudoaneurysm after Living Donor Liver Transplantation. BMC Gastroenterology, 16, Article No. 44. https://doi.org/10.1186/s12876-016-0458-8
- 16. Saad, W.E.A., Dasgupta, N., Lippert, A.J., et al. (2013) Extrahepatic Pseudoaneurysms and Ruptures of the Hepatic Artery in Liver Transplant Recipients: Endovascular Management and a New Iatrogenic Etiology. Cardiovascular and Interventional Radiology, 36, 118-127. https://doi.org/10.1007/s00270-012-0408-y
- 17. Lima, C.X., Mandil, A., Ulhoa, A.C., et al. (2009) Splenic Artery Steal Syndrome after Liver Transplantation: An Alternative Technique of Embolization. Transplantation Proceedings, 41, 1990-1993. https://doi.org/10.1016/j.transproceed.2009.01.086
- 18. Obmann, V.C., Chalian, M., Mansoori, B., et al. (2018) Advantages of Time-Resolved Contrast-Enhanced 4D MR Angiography in Splenic Arterial Steal Syndrome. Clinical Imaging, 49, 169-173. https://doi.org/10.1016/j.clinimag.2018.03.003
- 19. Gad, E.H., Abdelsamee, M.A. and Kamel, Y. (2016) Hepatic Arterial and Portal Venous Complications after Adult and Pediatric Living Donor Liver Transplantation, Risk Factors, Management and Outcome (a Retrospective Cohort Study). Annals of Medicine and Surgery (2012), 8, 28-39. https://doi.org/10.1016/j.amsu.2016.04.021
- 20. Zhan, H.X., Lv, Y., Zhang, Y., et al. (2008) Hepatic and Renal Artery Rupture Due to Aspergillus and Mucor Mixed Infection after Combined Liver and Kidney Transplantation: A Case Report. Transplantation Proceedings, 40, 1771-1773. https://doi.org/10.1016/j.transproceed.2007.10.013
- 21. Adani, G.L., Baccarani, U., Risaliti, A., et al. (2007) Percutaneous Transhepatic Portography for the Treatment of Early Portal Vein Thrombosis after Surgery. Cardiovascular and Interventional Radiology, 30, 1222-1226. https://doi.org/10.1007/s00270-007-9056-z
- 22. Ghabril, M., Agarwal, S., Lacerda, M., et al. (2016) Portal Vein Thrombosis Is a Risk Factor for Poor Early Outcomes after Liver Transplantation: Analysis of Risk Factors and Outcomes for Portal Vein Thrombosis in Waitlisted Patients. Transplantation, 100, 126-133. https://doi.org/10.1097/TP.0000000000000785
- 23. 陈喜萍, 唐毅. 超声在小儿肝移植后血管并发症中的应用进展[J]. 中国医学影像技术, 2020, 36(2): 299-302.
- 24. Tannuri, U., Tannuri, A.C.A., Santos, M.M., et al. (2015) Technique Advance to Avoid Hepatic Venous Outflow Obstruction in Pediatric Living‐Donor Liver Transplantation. Pediatric Transplantation, 19, 261-266. https://doi.org/10.1111/petr.12429
- 25. Sakamoto, S., Ogura, Y., Shibata, T., et al. (2009) Successful Stent Placement for Hepatic Venous Outflow Obstruction in Pediatric Living Donor Liver Transplantation, Including A Case Series Review. Pediatric Transplantation, 13, 507-511. https://doi.org/10.1111/j.1399-3046.2008.01003.x
- 26. Krishna Kumar, G., Sharif, K., Mayer, D., et al. (2010) Hepatic Venous Outflow Obstruction in Paediatric Liver Transplantation. Pediatric Surgery International, 26, 423-425. https://doi.org/10.1007/s00383-010-2564-y
- 27. Kawano, Y., Mizuta, K., Sanada, Y., et al. (2016) Complementary Indicators for Diagnosis of Hepatic Vein Stenosis after Pediatric Living-Donor Liver Transplantation. Transplantation Proceedings, 48, 1156-1161. https://doi.org/10.1016/j.transproceed.2015.12.114
- 28. Nomura, R., Ishizaki, Y., Sugo, H., et al. (2010) Late‐Onset Venous Outflow Obstruction Treated by Placement of a Foley Balloon Catheter in Living Donor Liver Transplantation Using a Left Lobe. Clinical Transplantation, 24, 723-725. https://doi.org/10.1111/j.1399-0012.2010.01227.x
- 29. Umehara, M., Narumi, S., Sugai, M., et al. (2012) Hepatic Venous Outflow Obstruction in Living Donor Liver Transplantation: Balloon Angioplasty or Stent Placement? Transplantation Proceedings, 44, 769-771. https://doi.org/10.1016/j.transproceed.2012.01.048
- 30. Wahab, M.A., Shehta, A., Hamed, H., et al. (2015) Hepatic Venous Outflow Obstruction after Living Donor Liver Transplantation Managed with Ectopic Placement of a Foley Catheter: A Case Report. International Journal of Surgery Case Reports, 10, 65-68. https://doi.org/10.1016/j.ijscr.2015.03.017
- 31. Sanchez-Ocaña, R., Tejedor-Tejada, J., Cimavilla-Roman, M., et al. (2019) Utility of Oral Anticoagulants as Prophylaxis of Recurrent Portal Thrombosis after Liver Transplantation. Transplantation Proceedings, 51, 83-86. https://doi.org/10.1016/j.transproceed.2018.07.014
- 32. Kim, K.S., Lee, J.S., Choi, G.S., et al. (2018) Long-Term Outcomes after Stent Insertion in Patients with Early and Late Hepatic Vein Outflow Obstruction after Living Donor Liver Transplantation. Annals of Surgical Treatment and Research, 95, 333-339. https://doi.org/10.4174/astr.2018.95.6.333
- 33. Ruiz, C.S., Kalbaugh, C.A., Browder, S.E., et al. (2020) Operative Strategies for Inferior Vena Cava Repair in Oncologic Surgery. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 8, 396-404. https://doi.org/10.1016/j.jvsv.2019.09.012
- 34. Chen, T.H., Jeng, L.B., Lee, C.C., et al. (2008) Polytetrafluoroethylene Patch Venoplasty for Outflow Reconstruction in Living Donor Liver Transplantation: Two Case Reports. Transplantation Proceedings, 40, 2529-2530. https://doi.org/10.1016/j.transproceed.2008.07.035
- 35. Hwang, S., Jung, D.H., Ha, T.Y., et al. (2012) Usability of Ringed Polytetrafluoroethylene Grafts for Middle Hepatic Vein Reconstruction during Living Donor Liver Transplantation: Hwang et al. Liver Transplantation, 18, 955-965. https://doi.org/10.1002/lt.23456
- 36. Lee, S.H., Na, G.H., Choi, H.J., et al. (2019) Impact of the Reconstruction Material On the Patency of Middle Hepatic Vein in Living Donor Liver Transplantation Using the Right Liver. Transplantation Proceedings, 51, 2745-2749. https://doi.org/10.1016/j.transproceed.2019.03.075
- 37. Ko, G.Y., Sung, K.B., Yoon, H.K., et al. (2008) Early Posttransplant Hepatic Venous Outflow Obstruction: Long-Term Efficacy of Primary Stent Placement. Liver Transplantation: Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 14, 1505-1511. https://doi.org/10.1002/lt.21560
- 38. Hsu, S.C., Thorat, A., Yang, H.R., et al. (2017) Assessing the Safety of Expanded Polytetrafluoroethylene Synthetic Grafts in Living Donor Liver Transplantation: Graft Migration into Hollow Viscous Organs-Diagnosis and Treatment Options. Medical Science Monitor, 23, 3284-3292. https://doi.org/10.12659/MSM.902636
- 39. Kumar, V.A., Brewster, L.P., Caves, J.M., et al. (2011) Tissue Engineering of Blood Vessels: Functional Requirements, Progress, and Future Challenges. Cardiovascular Engineering and Technology, 2, 137-148. https://doi.org/10.1007/s13239-011-0049-3
- 40. Hazama, K., Miura, H., Shimada, T., et al. (2004) Relationship between Fibril Length and Tissue Ingrowth in the Healing of Expanded Polytetrafluoroethylene Grafts. Surgery Today, 34, 685-689. https://doi.org/10.1007/s00595-004-2774-9
- 41. Esposito, F., Lim, C., Salloum, C., et al. (2017) Intragastric Migration of a Mesentericoportal Polytetrafluoroethylene Jump Graft after Liver Transplantation. Liver Transplantation, 23, 696-697. https://doi.org/10.1002/lt.24747
- 42. Sultan, A.M., Shehta, A., Salah, T., et al. (2018) Spontaneous Migration of Thrombosed Synthetic Vascular Graft to the Duodenum after Living-Donor Liver Transplantation: A Case-Report. International Journal of Surgery Case Reports, 45, 42-44. https://doi.org/10.1016/j.ijscr.2018.03.013
- 43. Park, G.C., Hwang, S., Ha, T.Y., et al. (2019) Hemashield Vascular Graft Is a Preferable Prosthetic Graft for Middle Hepatic Vein Reconstruction in Living Donor Liver Transplantation. Annals of Transplantation, 24, 639-646. https://doi.org/10.12659/AOT.919780
NOTES
*通讯作者。