原位肝移植肝动脉重建的外科技巧

目的 探讨肝脏移植肝动脉重建的外科技巧和影响肝动脉重建效果的因素.方法 对2004-2005年施行的368例同种原位肝移植病人的临床资料进行分析总结.结果 368例肝移植病人中与动脉相关的并发症共22例,发生率为5.9%(22/368);围手术期发生的15例动脉相关并发症中,12例为动脉血栓形成,3例为误伤右副肝动脉而继发的大面积肝坏死;术后远期发生的7例动脉相关并发症中,动脉血栓形成3例和动脉广泛狭窄4例.所有22例动脉相关的并发症中,接受再次肝脏移植者13例.因肝动脉并发症导致病人死亡11例,占该组肝移植病人死亡的30.5%(11/36).结论 保护供体肝动脉的完整性、正确选择受体动脉的吻合部位、显微外科血管重建技术的应用以及预防或及时纠正血液高凝状态等是提高肝动脉重建质量,降低肝动脉并发症发生率的重要因素.

Surgical techniques of hepatic artery reconstitution in orthotopic liver transplantation

Objective To investigate the surgical techniques of hepatic artery reconstitution in liver transplantation and the factors influencing quality of hepatic artery reeonstitution.Methods The clinical data of 368 cases receiving allograft orthotopic liver transplantation in our hospital were retrospectively analyzed.Results Twenty-two cases of the 368 had complication related tO with artery and the rate was 5.9%(22/368).Fifteen cases of complication related tO artery oecurred in perioperative period,including 12 cases of arterial thrombosis and 3 cases of a large area hepatic necrosis because of injury of right accessory hepatic artery by mistake.Seven cases of complication related to artery occurred in long-term after operation,including 3 cases of arterial thrombosis and 4 cases of hepatic artery stenosis.Thirteen patients with hepatic artery complication underwent another liver transplantation.Eleven death cases occurred because of artery complication and the rate was 30.5% (11/36).Conclusion Protecting the integrity of donor hepatic artery,reasonable selection of the anastomosis location of recipient artery,application of microsurgical techniques and prophylaxis and rectification of blood hypercoagulabale state are the important factors to promote the quality of hepatic artery reconstitution and lower the complication rate related tO hepatic artery.