肝动脉-腹主动脉架桥重建移植肝肝动脉74例报告

探讨原位肝移植术中采用肝动脉-腹主动脉架桥重建移植肝肝动脉的疗效.方法 回顾分析2003年10月至2009年8月在中山大学附属第三医院肝移植中心行肝动脉-腹主动脉架桥重建移植肝肝动脉的74例患者的临床资料.全部患者采用供肝动脉通过供者髂动脉间置架桥与受者腹主动脉(肾动脉下方腹主动脉)行端侧吻合.总结手术治疗方法和术后并发症发生情况.所有患者均签署知情同意书,符合医学伦理学规定.结果 74例采用肝动脉-腹主动脉架桥重建肝动脉的患者中,68例治愈,6例术后早期死亡,治愈率为92%.术后急性排斥反应的发生率为18%(13/74),胆道并发症发生率为11%(8/74),肝动脉并发症发生率为14%(10/74),其中5例为架桥动脉血栓形成,5例为肝动脉(含架桥动脉)狭窄,行动脉支架置入溶栓术或动脉支架置入术,除1例上述治疗无效后行再次肝移植外,其余9例血管恢复通畅.结论 肝移植术中若无法行供、受者肝动脉端端吻合术重建肝动脉,间置髂动脉的肝动脉-腹主动脉架桥术是一种安全可靠的肝动脉重建方法.

Reconstruction of graft hepatic artery with iliac arterial interposition between hepatic artery and abdominal aorta:74 cases report

Objective To investigate the efficacy of reconstruction of graft hepatic artery with iliac arterial interposition between hepatic artery and abdominal aorta in orthotopic liver transplantation. Methods Clinical data of 74 patients were analyzed retrospectively, who underwent reconstruction of graft hepatic artery with iliae arterial interposition between hepatic artery and abdominal aorta in liver transplant center of the Third Affiliated Hospital of Sun Yat-sen University from October 2003 to August 2009. All of the patients had their hepatic arteries reconstructed by end-to-side anastomosis of the donor＇s iliae arterial interposition graft on the recipient＇s abdominal aorta （ infrarenal abdominal aorta）. The surgical therapy and occurrence of post-operative complications were summarized. This study was approved by local ethical committee and the informed consent of all participating subjects was obtained. Results In 74 patients underwent reconstruction of graft hepatic artery with iliac arterial interposition between hepatic artery and abdominal aorta, 68 cases were cured and 6 cases died in the early stage after liver transplantation. The cure rate was 92%. The incidence of acute rejection was 18% （13/74）, the incidence of biliary complication was 11% （8/74）, and the incidence of arterial complication was 14% （10/74）. In 10 cases with arterial complication, 5 cases developed thrombosis in bypass artery and 5 cases developed hepatic artery （including bypass artery） stenosis. The 10 patients underwent arterial stenting or combined with thrombolysis. The treatment was ineffective in one case and the patient received liver retransplantation. The other 9 cases recovered. Conclusions Bypass reconstruction with iliac arterial interposition between hepatic artery and abdominal aorta is a safe alternative for arterialrevascularization of liver allograft under the circumstances that the hepatic artery can not be reconstructed by end-to-end anastomosis of hepatic artery between donor and repicient.