肝移植术后肝动脉血栓形成的预防

目的 探讨肝移植术后肝动脉血栓形成(hepatic artery thrombosis,HAT)的预防.方法 2004年1月至2007年12月我院器官移植科共实施596例成人尸肝移植,自2005年开始采取综合措施预防HAT形成,包括术中重建变异肝动脉,受体肝动脉条件不好的患者采取供体肝动脉与受体腹主动脉搭桥,动脉吻合全部采用显微缝合技术,术后常规监测移植肝血流,对肝动脉峰值流速低于40 cm/s的患者行抗凝治疗.比较2004年实施的181例肝移植患者(A组)与2005-2007年实施的415例肝移植患者(B组)HAT发生情况.结果 A组共有8例患者出现HAT,发生的中位时间为术后11 d(3～41 d),3例表现为急性肝功能恶化,3例表现为胆漏,1例表现为肝脓肿,1例无明显临床症状.B组共有6例患者出现HAT,发生时间为术后8 d(1～21 d),3例表现为急性肝功能恶化,1例表现为胆漏,2例无明显临床症状.B组患者HAT发生率明显低于A组(1.44%vs4.42%,X~2=4.86,P=0.027).A组3例行再次肝移植,共死亡5例,B组3例行肝动脉重建联合肝动脉局部溶栓治疗,2例患者康复出院,1例患者因严重感染、肾功能衰竭死亡.3例患者接受再次肝移植.结论 肝动脉血栓形成是肝移植术后的严重并发症,术中采用显微缝合方式,注意重建变异肝动脉,术后严密监测,及时抗凝治疗可以有效预防肝动脉血栓形成.

Hepatic artery thrombosis after liver transplantation

Objective To evaluate measures used in the prevention of hepatic artery thrombosis (HAT) after orthotopic liver transplantation.Methods Five hundred and ninety-six adult patients received liver transplantation in this single center from Jan.2004,to Dec.2007,Series of measures were taken to prevent the formation of hepatic artery thrombosis (HAT),including reconstruction of variant arteries,bridge to the recipients' abdominal aorta,microsurgical techniques in artery anastomosis,dynamically detecting the blood flow of the graft and anticoagulation in selected recipients in which hypercoagulation was suspected.Patients were divided into group A (181 cases in 2004) and group B (415 cases in 2005-2007).Results Eight patients experienced HAT on 11 d(3-41d) after transplantation in group A,3 of them had liver function deterioration,3 had bile leakage,1 had hepatic abscess and 1 was of no symptoms.Six patients had HAT on 8 d (1-21d) post transplantation in group B,3 of them had liver function deterioration,1 had bile leakage and the other 2 had no clinical symptoms.The incidence rate of HAT in group B after taking preventive strategies was significantly lower than that in group A (1.44% vs 4.42,X~2 = 4.86,P=0.027).Three patients received retransplantation and 5 died in group A,3 patients received retransplantation and 2 died in group B.Conclusions HAT is a severe complication after liver transplantation.Perioperative measures including microsurgical techniques,management of the coagulating dysfunctions,monitoring the blood flow with color Doppler ultrasound and prompt anticoagulant therapies are important to prevent HAT.