活体肝部分移植术后肝动脉血栓的诊治及预防

目的 探讨求知 体肝部分移植术后肝动脉血栓的症状、诊治及预防措施。方法 在日本长崎大学对1例急性重症肝及3例先天笥胆道闭锁患者行活体肝部分移植。术后常规使用彩色超声波监测血管并发症。结果 第1例未行抗凝治疗，在术后第3天出现了肝动脉血栓，施行紧急手术，摘除血栓，行肝动脉再吻合术，术后予抗凝治疗，后3例受体术后常规抗凝固治疗，未发生肝动脉血栓，随访6个月4例均存活良好。结论 在显微外科的条件下吻合细小的肝动脉，通过彩色超声波检查来诊断血管并发症，术后常规的抗凝治疗是预防血栓形成的有效方法。

Diagnosis, treatment and prevention of the hepatic artery thrombosis caused by living related liver transplantation

Objective To discuss the symptom, diagnosis, treatment and prevention of hepatic artery thrombosis caused by living related liver transplantation. Methods Four cases of living related liver transplantation in Nagasaki University and measures of preventing the postoperative hepatic artery thrombosis were discussed. Results Microsurgery technique was used to anastomose hepatic artery and color ultrasound was used to monitor vascular complication in all four cases. Formation of hepatic artery thrombosis was found in the first case without treatment of anticoagulant on the third day after transplantation. Thrombosis extirpation and hepatic artery reanastomosis was initiated as first aid, followed by anticoagulant treatment. No hepatic artery thrombosis was found in other three cases under conventional anticoagulant treatment. All cases are in good condition now. Conclusion The effective ways to prevent formation of thrombosis include improving vascular anastomosis techniques, anastomosing mini hepatic artery under microsurgery condition, and detecting vascular complication by using color ultrasound and postoperative anticoagulation.