供肝127例变异肝动脉修整和重建技术体会

目的探讨在供肝修整中防止变异性肝动脉损伤的注意事项。方法总结598例供肝修整中127例肝动脉变异发生率、类型；动脉误伤和重建前后情况。并对供肝修整的技巧进行回顾性分析。结果在598例供肝中按Hiatt分型Ⅰ型471例（75．7％，471／598），Ⅱ型51例（9．7％．51／598），Ⅲ型57例（10．6％，57／598），Ⅳ型8例（2.3％，8／598），Ⅴ型7例（1．5％，7／598），Ⅵ型4例（0．2％，4／598）；其中供肝动脉变异127例（21．2％，127／598），供肝获取、修整时动脉损伤25例（4．2％，25／598，正常肝动脉损伤5例，变异肝动脉损伤20例）；动脉重建共75例（12．5％．75／598），其中变异动脉70例。动脉重建方法选择变异或损伤动脉合适部位整形，尽量单次吻合完成植入前重建，包括变异动脉与脾动脉（52／127）、胃十二指肠动脉（18／127）、腹腔干（3／127）及肝总动脉（2／127）吻分。结论在供肝修整中应高度重视肝动脉变异问题；注重供肝修整顺序和方法;掌握好解剖学特点，辨别动脉变异、小心细致地选择适宜的方式修整和重建；才是肝移植术中防止动脉并发症发生的技术关键。

Experience of repair and reconstruction to 127 cases hepatic artery with anatomical variation in liver transplantation

Object To discuss the experience of repair and reconstruction of hepatic artery with anatomical variation in liver transplantation.Methods 127 cases of variated hepatic arteries in 598 donor livers were retrospectively reviewed,the aberrant status and type of variation were analyzed,the method of preventing injure and microsurgical reconstruction technique to variated hepatic arteries were summarized.Resuts 598 cases of liver transplantation were classificated according to Hiatt typing method.Type I were 47...