成人肝移植中的肝动脉搭桥术——澳大利亚 Australia National Liver Transplant Unit的经验

目的 介绍澳大利亚国家肝移植中心在成人肝移植中应用肝动脉搭桥术的经验。方法 对澳大利亚国家肝移植中心（Australia National Liver Transplant Unit，ANLTU）1986—2003年的31例行肝动脉搭桥的成人肝移植结果进行回顾行分析。31例需行肝动脉搭桥的原因有微小受者肝动脉、肝动脉血栓症、肝门严重粘连、肝动脉壁间动脉瘤、真菌性肝动脉瘤及前次植入肝的肝动脉因胆道出血而结扎。18例为首次移植，13例为再次或多次肝移植。结果 术后15例（48．4％）存活，平均存活时间为4．1年，16例（51．6％）死亡，平均存活时间为34．56d。两次和多次肝移植者的死亡率为76．9％，首次肝移植者的死亡率为33．3％（P〈0．05）。因肝动脉血栓症而搭桥者的死亡率最高，其次为肝门严重粘连者。死亡原因依次为败血症、围手术期大出血、颅内出血、肝动脉血栓形成、排斥反应、原发病复发以及心跳骤停。结论 成人肝移植行肝动脉搭桥的适应证主要是各种原因导致的受者肝动脉不适用，或因肝门部严重粘连而无法解剖者；患者术后转归与肝移植的次数及患者的术前状况有关。

Adult orthotopic liver transplantation with arterial conduit usage for hepatic artery revascularisation: the experience of Australia National Liver Transplant Unit

Objective To introduce the experience of Australia National Liver Transplant Unit (ANLTU) about adult orthotopic liver transplantation with arterial conduit usage for hepatic artery revascularization. Methods The 31 cases of adult orthotopic liver transplantation with arterial conduit usage for hepatic artery revascularization from 1986 to 2003 in the ANLTU were identified from records. The indication of arterial conduit use was as following: small caliber of hepatic artery (HA), HAT, hepatic hila adhesion, dissection of HA, mycotic aneurysm-ligated and ligated HA for haemobilia of the first graft. Eighteen of 31 cases were primary transplant and the others were retransplant. Results Fifteen patients ( 48.4 %) were alive at the time of data analysis. The mean survival time for the survivors was 4.1 years compared to a mean survival time of 34.56 days for 16 patients ( 51.6 %) who deceased. The mortality was 76.9 % in retransplant cases versus 33.3 % in primary transplant (P< 0.05). It was the highest mortality for the patients with HAT to use arterial conduit for HA revascularization, and secondary for whom with severe hepatic hila adhesion. The most common causes of patient mortality were sepsis ( 37.5 %), hemorrhage ( 31.25 %). Conclusion The indication of arterial conduit use for HA revascularization in adult orthotopic liver transplantation is as follows: unusable HA for various causes and severe hepatic hila adhesion in the recipient. Mortality is associa- ted with retransplantation and a high pretransplant worse status in this series.