供肝动脉变异和植入前动脉重建

目的探讨供肝动脉变异类型,术中损伤原因及植入前重建的方法。方法1993年10月至2004年12月,中山大学附属第三医院肝脏移植中心共行供肝切取和修整术600例,术中记录肝动脉变异类型和术中动脉误伤,重建变异肝动脉,形成单一的备吻合血管。结果在600例供肝中,19·2%(115/600)供肝动脉变异。53例(53/600)变异动脉须血管重建,其中39例(39/53)代替性或副肝右动脉来自肠系膜上动脉,1例(1/53)代替性肝右动脉来自腹腔干,5例(5/53)代替性或副肝左动脉来自胃左动脉,2例(2/53)变异肝左动脉和3例(3/53)变异肝右动脉离断后来源不清,3例(3/53)变异肝左和肝右动脉双重替代。6例(6/485)供肝切取术中意外损伤正常肝动脉,需要动脉重建。变异肝动脉损伤19例(19/115),均行动脉重建。动脉重建方法包括变异动脉与脾动脉(36/53)、胃十二指肠动脉(12/53)以及复杂的吻合方法(5/53)。结论供肝快速切取过程中,肝动脉变异增加肝动脉意外损伤发生率,损伤变异动脉均须在植入前重建。变异动脉重建方法的选择取决于肝动脉解剖学特点。

Variation of the hepatic arteries of donor livers and arterial reconstruction prior to liver transplantation

Objective To explore variantion type,the cause of accident injury during the operation and reconstruction menthod of the donor hepatic arteries before liver transplantation.Methods Between October 1993 and December 2004,600 cases were performed orthotopic liver transplantation in the Liver Transplant Center of Third Affiliated Hospital of Sun Yat-sen University.The anatomy and accidental injury of the hepatic artery were recorded. Vascular reconstruction was performed to obtain single artery for anastomosis.Results The artery anatomy was anomalous in 115 (19.2%) out of 600 donor livers.Fifty-three variant arteries were reconstructed.Among them,39(39/53) replaced or accessory right hepatic arteries originated from superior mesenteric artery.One(1/53)replaced right artery originated from celiac trunk. Five (5/53) replaced or accessory left hepatic arteries originated from left gastric artery.The origination of 2 (2/53)variant left and 3(3/53) variant right hepatic arteries was not found.Three (3/53) replaced systems were double.Six cases (6/485) of accidental injury of normal hepatic arteries occurred during harvesting operation.And 19 cases (19/115)of accident injury of variant hepatic arteries occurred. Splenic arteries(36/53) and gastro-duodenal artery(12/53) were typically used for anastomosis of the variant hepatic arteries and other complex techniques(5/53) were chosen.Conclusions During rapid donor liver harvesting,the incidence of accident injury of hepatic artery is increased by presence of hepatic arterial variation.All variant hepatic arteries injured accidentally will be reconstructed before liver transplantation.The type of appropriate reconstruction of variant hepatic arteries is dependent upon hepatic artery anatomy.