原位肝移植肝动脉并发症的防治

目的 探讨原位肝移植肝动脉并发症的预防及治疗。方法 回顾性分析1999年2月至2001年2月完成的22例原位肝移植，其中4例行体外静脉转流下的原位肝移植术，17例行背驮式原位肝移植，1例为活体供肝部分肝移植。11例供肝的肝固有动脉与受者的肝固有动脉吻合，4例供者脾动脉与受者肝总动脉吻合，3例供者腹腔动脉与受者肝总动脉吻合，2例应用供者髂动脉在供者肝固有动脉与受者腹主动脉间架桥吻合，1例供者肝右动脉与受者肝固有动脉吻合，1例供者肝固有动脉与受者异位肝右动脉吻合。术后以多普勒超声扫描监测肝动脉血流。结果 1例术后5d时发生肝动脉血栓形成，以尿酶介入溶栓后出现吻合口出血，再次手术行肝动脉吻合。21例无肝动脉并发症发生。15例随访1－20个月，多普勒超声扫描提示肝动脉血流、形态正常，胆道造影未见肝外胆管狭窄，血清学检查提示肝功能状态良好。结论 原位肝移植预防肝动脉并发症的关键在于血管吻合时操作精细，实现血管内膜对内膜的无张力吻合。

Prevention and management of hepatic artery complications following orthotopic liver transplantation

Objective To explore the prevention and management of hepatic artery complications following orthotopic liver transplantation.Method A retrospective analysis was made for 22 cases of orthotopic liver transplantation performed in our institute from Feb. 1999 to Feb. 2001. The recipient operation was performed using standard method with the routine use of veno venous bypass in 4 patients and piggyback method in 17 patients and living related liver transplantation in one patient. All the blood vessels were anastomosed with running suture of Prolene. No operating microscope was employed. Dipyridamole was administered intravenously 10?ml/h in the first week postoperative period. The flow of hepatic artery was checked by Doppler ultrasound.Results One patient developed hepatic artery thrombosis in the 5th post operative day and revascularized by intrarterial declotting with urokinase. One to 20 months (mean 8.6 months) of follow up in 15 patients revealed that hepatic artery flow remained normal by Doppler ultrasound, cholangiogram showed no ertrahepatic biliary tract stricture and serological examinations proved that liver grafts functioned well in these patients. Conclusion To prevent hepatic artery complications, it is crucial to make an effort to obtain perfect intima to intima apposition of end to end anastomosis.