R.F. da Silva, R. Raphe, H.C. Felício, M.F. Rocha, W.J. Duca, P.C.J. Arroyo, G.L. Palini, A.M. Vasquez, D.G. Miquelin, L.F. Reis, A.A.M. Silva, R.C.M.A. da Silva

简介：肝移植后肝动脉狭窄（HAS）会导致肝功能改变和/或血栓形成，从而增加患者的发病率和死亡率。据文献资料显示，HAS的流行率从4%至11%不等。

目标：研究肝移植后动脉狭窄的流行性及其治疗方法。

方法：我们对1998年3月至2007年5月期间进行肝移植手术的患者进行了详细的回顾分析，涉及到的研究对象包括由于肝酶增加、多普勒超声（US）改变和肝活检得出的疑似HAS患者。通过动脉X光造影能够确诊HAS。

结果：已经有9名患者被确诊患有HAS，流行率为3.5%。在这9名HAS患者中，7名为男性，2名为女性，患者的平均年龄为35.5岁。从确诊到肝移植的平均时间间隔为14.2个月（范围是9至68个月）。该组患者中增加的肝酶平均为：天冬氨酸氨基转移酶131 U/L（范围是26至412）和丙氨酸转氨酶192 U/L（范围35至511）。多普勒US显示了电阻水平指数的改变。所有的患者都进行了动脉X光造影；仅有一名患者因为严重的肝动脉痉挛而不能实施造影，数周之后另一名患者也出现了同样的情况。在8名患者中，6名患者采用支架治疗，另外2名采用血管修复术进行治疗。所有接受治疗的患者病情都得到了改善。4名采用支架疗法的患者需要再次治疗，因为2名患者进行了血管修复，另外2名患者使用了血栓溶解剂。一例移植物再次出现血栓，但该血栓与其他脉络的再次畅通相抵消。该组患者中没有出现移植物失功能或患者死亡事件。患者在接受治疗后的平均随访时间为31.28个月（范围是9至68个月）。

结论：本研究中得出的HAS流行率在文献描述的范围之内。在使用支架疗法或动脉X光造影时患者的肝功能得到了恢复，同时也没有出现移植物失功能或患者死亡的情况，由此我们得出，支架疗法和动脉X光造影对于控制这种并发症有一定的疗效。

Prevalence, Treatment, and Outcomes of the Hepatic Artery Stenosis After Liver Transplantation
R.F. da Silva, R. Raphe, H.C. Felício, M.F. Rocha, W.J. Duca, P.C.J. Arroyo, G.L. Palini, A.M. Vasquez, D.G. Miquelin, L.F. Reis, A.A.M. Silva, R.C.M.A. da Silva

Introduction：Hepatic artery stenosis (HAS) after liver transplantation can lead to altered hepatic function and/or thrombosis, there by increasing morbidity and mortality. The prevalence of HAS in the literatures varies from 4% to 11%.

Objective：We sought to describe the prevalence and treatment of hepatic artery stenosis.

Methods：We performed a descriptive retrospective analysis of 253 liver transplantations from March 1998 to May 2007, including patients with suspected HAS owing to increased hepatic enzymes, altered Doppler ultrasound (us) and hepatic biopsy. The confirmation of HAS was achieved through areriography.

Results：Nine patients were identified to have HAS, a 3.5% prevalence. Among the HAS patients, seven were male and two female. Their average age was 35.5 years (range, 65 to 53). The average time between the diagnosis and transplantation was 14.2 months (range, 9 to 68). The increase in hepatic enzymes among this group averaged: aspartate aminotransferase 131 U/L (range, 26 to 412) and alanine aminotransferase 192 U/L (range, 35 to 511). Doppler US showed alteration in the resistance level index. All patients underwent areriography; only one could not be treated owing to severe hepatic artery spasm, which also occurred during another attempt weeks after the first one. Among the eight patients, six were treated with stents and two with angioplastis. All treated patients displayed improvements in parameters. Four patients treated with stents required retreatment: two underwent angioplasty and two, a thrombolytic. One graft rethrombosed but evolved in compensated fashion with recanalization by collaterals. There has been no graft loss or mortality in this population. The average time of posttreatment follow-up was 31.28 (range, 9 to 68) months.

Conclusion：The prevalence of HAS in our unit was within that reported in the literature. Treatment with a stent or angioplasty proved to be efficient to control this complication, considering that hepatic function recovered and that there was neither graft nor patient loss.

Volume 40, Issue 3, Pages 805-807 (April 2008)

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