不同切取方法对肝移植供肝动脉解剖变异的损伤分析

目的 探讨供肝切取修整的方法及肝动脉常见变异,预防供肝切取修整过程中肝动脉损伤.方法 回顾性分析2001年6月至2006年7月共计843例供肝切取修整及肝动脉变异资料,其中148例供肝采用肝肾分开切取方法,695例供肝采用腹部脏器联合切取方法.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843例供肝中,肝动脉解剖变异者172例,总变异率20.4%(172/843),发生频率最高的为右肝动脉起源于肠系膜上动脉(57例)及左肝动脉起源于胃左动脉(54例),高变异率伴随着高损伤率.结论 腹部脏器联合切取方法可减少肝动脉意外损伤发生率,熟悉常见肝动脉变异类型和精细的解剖是减少肝动脉损伤的关键.

Relationship between variation of donor hepatic artery injury and different procurement methods

Objective To investigate the incidence of anatomic variations of hepatic artery and methods of procurement and reconstruction to prevent the accidental injury of the hepatic artery.Methods The clinical data of 843 patients receiving orthotopic liver transplantation (OLT) in our hos-pital from June 2001 to July 2006 were retrospectively analyzed. Liver and kidney separate procure-ment was performed for 148 cases and abdominal organ combined procurement in 695. The variations of the hepatic artery as well as the relationship between the anomalous hepatic artery and accidental in-jury of the hepatic artery were analyzed. Results Anatomic variations of hepatic artery which were most frequently observed, were the right hepatic artery originating from the superior mesenteric artery and left hepatic artery originating from left gastric artery. The rate of the anomalous hepatic artery concomitancy increased along with elevation in the rate of accidental injury. Conclusion Abdominal or-gan combined procurement can reduce the incidence of accident injury of hepatic artery. Familiarity of the he-patic arterial variation and careful anastomosis are important to reduce injury of the hepatic artery.