肝脏移植术中肝动脉并发症的预防

目的　探讨肝移植术后肝动脉栓塞或狭窄的预防。方法　将供肝肝动脉至腹腔动脉起始部一并切取 ,在修整肝动脉时 ,尽量保留其全部 ;同时避免动脉的损伤 ,尤其动脉主干及分支内膜。肝移植术中 ,供、受体门静脉吻合开放后 ,选择内膜完整、与供肝动脉口径相匹配的血管 ,直接行端端吻合。若术中发现血管内径较细 ,无论是供、受者动脉均应寻找动脉主干与血管分叉处 ,剪开分叉处 ,使动脉吻合口呈喇叭口状 ,并保护动脉内膜不受损伤。在肝动脉重建过程中 ,保证内膜的完整性。结果　 36例肝移植术后患者经B超证实无 1例发生肝动脉并发症。结论　供体器官完整的动脉采集、术中合理的动脉选择、精确的血管吻合技术及术后的适当抗凝是预防肝移植肝动脉并发症的重要因素。

PREVENTION OF COMPLICATIONS RELATING WITH HEPATIC ARTERY IN ORTHOTOPIC LIVER TRANSPLANTATION(OLT)

Objective To discuss and prevent hepatic artery thrombosis (HAT ) or stenosis (HAS) after orthotopic liver transplantation (OLT). Methods In harvesting the donor's liver, the hepatic artery should be obtained together with its origin from the celiac artery as a whole. Damage to the hepatic artery should be avoided during dissection, the endothelium should not be injured, especially that of its branches. When the portal veins of the donor and the recipient were opened, the matching arteries were anastomosed end to end. If the diameter of the anastomosing artery was less than 5 mm, a branching section of the artery was selected, the bifurcation septum was divided so that the arterial end was enlarged to ensure a good anastomosis. The endothelium of the artery should be kept intact during the procedure. Results In 36 patients with OLT, no patients suffered from HAT or HAS. Conclusion The important procedures to prevent HAT or HAS in OLT are harvest of a complete donor's arteries, suitable selection of hepatic artery for anastomosis, precise technique of vascular anastomosis, and appropriate use of anticoagulant.