肝移植术后门静脉吻合口重度狭窄TIPS失败后血管内支架置入一例
本文报道一例肝移植术后门静脉吻合口重度狭窄患者，表现为持续性腹水，多普勒超声和CT血管成像提示门静脉与肠系膜曲张静脉复杂吻合处局灶性狭窄。TIPS尝试因狭窄段无法安全通过而失败，但静脉造影提供了支持血流动力学相关梗阻的线索。次日经皮经肝途径明确显示短段重度狭窄，并成功行球囊辅助支架置入，早期多普勒超声显示门静脉向肝血流恢复。
要点
- 肝移植术后持续性腹水需警惕门静脉吻合口狭窄，多普勒超声和CT血管成像是首选无创评估手段。
- TIPS失败后，静脉造影可提供血流动力学梗阻的间接证据，经皮经肝途径可明确狭窄并指导支架置入。
- 球囊辅助支架置入可有效治疗短段重度门静脉吻合口狭窄，术后多普勒超声可早期评估血流恢复。
关键影像表现/征象
- 多普勒超声和CT血管成像提示门静脉与肠系膜曲张静脉复杂吻合处局灶性狭窄。
- 静脉造影提供支持血流动力学相关梗阻的附加线索。
- 经皮经肝途径明确显示短段重度狭窄。
- 支架置入后早期多普勒超声显示门静脉向肝血流恢复。
临床应用与阅片要点
- 肝移植术后持续性腹水患者应行多普勒超声和CT血管成像评估门静脉吻合口。
- TIPS失败后，静脉造影可提供血流动力学梗阻线索，经皮经肝途径可明确狭窄并指导治疗。
- 短段重度狭窄可行球囊辅助支架置入，术后多普勒超声早期评估向肝血流恢复。
局限性
- 单病例报告，结论推广受限。
- 缺乏长期随访和支架通畅率数据。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
Portal vein anastomotic stenosis after liver transplantation is an uncommon but clinically important complication that can lead to portal hypertension, ascites, and impaired graft inflow. We present a case of a liver transplant recipient with persistent ascites in whom Doppler ultrasound and CT angiography suggested a focal narrowing of a complex anastomosis between portal vein and mesenteric varicose veins. An attempted TIPS procedure was unsuccessful because the stenotic segment could not be safely traversed; however, venography provided additional clues supporting a hemodynamically relevant obstruction. On the following day, a percutaneous transhepatic approach enabled definitive visualization of a short, high-grade stenosis, which was successfully treated with balloon-assisted stent placement. Early Doppler ultrasound demonstrated restored hepatopetal portal flow. This case highlights the value of a staged percutaneous stent placement technique when TIPS is technically unfeasible.
引用
- Vogl TJ, Şahan M. Endovascular stent placement for severe post-transplant portal vein anastomotic stenosis following an unsuccessful TIPS attempt. Eur J Radiol. 2026. PMID: 41985311. doi:10.1016/j.ejrad.2026.112830
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。