肝移植中变异肝动脉的处理

目的探讨肝移植中变异肝动脉的保护及重建方法。方法回顾性分析2005年6月至2013年12月进行的340例肝移植的临床资料,着重分析变异肝动脉的保护及重建方法。取修肝过程注意保护变异的肝动脉,变异的肝动脉采用显微缝合技术与供受体腹腔动脉干的分支行端端吻合,术中根据变异动脉的条件,选择管径相互匹配、位置合适的腹腔动脉干的属支进行吻合,其中管径≧3 mm采用连续缝合;3 mm采用间断缝合。术后常规多普勒超声监测肝动脉血流情况,肝素+低分子右旋糖酐抗凝。结果 340例中出现肝动脉变异64例,其中左肝动脉变异33例,来源于胃左动脉20例、腹腔动脉干11例,腹主动脉2例;右肝动脉变异30例,来源于肠系膜上动脉19例,胃十二指肠动脉10例,腹主动脉1例;肝总动脉变异1例,来源于腹主动脉。误扎变异左肝动脉2例,术后出现左肝管缺血坏死2例。结论供肝肝动脉变异率高,取修肝过程中应注意对变异肝动脉的保护,选择供受体合适的腹腔动脉干分支与变异肝动脉吻合是处理肝动脉变异的良好方法。

Management of hepatic artery with anatomical variation in liver transplantation

Objective To explore the protection and reconstruction of hepatic artery with anatomical variation in liver trans- plantation. Methods Based on retrospective study of 340 cases of liver transplantation in our center from June 2005 to December 2013, we focused on t the protection and reconstruction of hepatic artery with anatomical variation in liver transplantation. Taking atten- tion to protect the hepatic artery with anatomical variation during the liver taken and repaired. A microtechnic end-to-end anastomosis was used in variant hepatic artery and the receptor celiac artery branches. Choose the right celiac artery branches to reconstruct with variation arterial depend on diameter match e, position. An interrupted anastomosis was used in which inner diameter was smaller than 3 millimetrums, while continuous fashion in which inner diameter was longer than 3 millimetrums. Doppler ultrasound was used to valu- ate the hepatic arterial blood flow after surgery. Anticoagulant with Dextran and heparin. Results 64 cases out of 340 had hepatic ar- tery with anatomical variation, in which the left variant hepatic artery in 33 cases, among which 20 cases from the left gastric artery, 1 l cases from celiac artery in and 2 cases from abdominal aorta; the right variant hepatic artery in 30 cases, among which 19 cases from the superior mesenteric artery, 10 cases from gastroduodenal artery and 1 case from abdominal aorta; the hepatic variant artery in one case, which came from the abdominal aorta. Left hepatic variant artery was ligated in error in 2 cases. Ischemic necrosis of the left he- patic duct were happened in 2 cases Postoperative. Conclusion The rate of hepatic Artery variation was high. Attention should be paid to the protection of the hepatic artery variation during the liver taken and repaired. A good method of reconstruction of hepatic artery variation is choosing the appropriate celiac artery branches to anastomy the variant hepatic artery.