421例同种原位肝移植肝动脉重建体会

目的探讨肝移植手术过程中肝动脉重建的技术要点,分析肝移植术后肝动脉合并症发生的原因。方法回顾性总结2000年5月至2006年5月,6年间我院连续实施的同种原位肝移植421例患者的临床资料,分析肝移植手术过程中可能影响肝动脉重建的因素,以及术后肝动脉合并症发生的可能原因,总结术中肝动脉重建的技术要点。结果421例肝移植患者中共发生肝动脉相关合并症者14例,发生率为3.3%,肝移植术后血管合并症主要是动脉血栓形成及肝动脉狭窄。14例合并症患者中死亡9例,死亡率为64.3%。按合并症出现时间分类,早期动脉合并症8例,死亡6例,晚期动脉合并症6例,死亡3例。结论供肝动脉的完整性、供受体动脉的重建方法以及显微外科技术的应用是影响肝动脉重建结果的重要因素。

Evaluation of hepatic artery reconstruction in 421 cases of orthotopic liver transplantation

Objective To evaluate the technical details of hepatic artery reconstruction and factors influencing the outcome of hepatic artery reconstruction in orthotopic liver transplantation,and analyse the causes of posttransplant hepatic artery complications in orthotopic liver transplantation.Methods A retrospective review of the clinical data of 421 consecutive orthotopic liver transplantation patients was performed to assess the key steps in hepatic artery reconstruction.The risk factors,diagnosis and treatment of vascular complications were also discussed.Result The incidence of hepatic artery related complications was 3.3%(14 cases),including early complication(within 4 weeks)of 8 cases and late complications of 6 cases,and the overall mortality rate was 64.3%(9 cases).The main hepatic artery related complications were hepatic artery thrombosis and stenosis.The incidence of the artery related complications in orthotopic liver transplantation was associated with the quality of the donor organ artery and the reconstruction method of donor-recipient artery intimately.Conclusions The integrity of donor liver's artery,technical expertise and the use of microsurgical technique are all the factors conducive to a successful hepatic artery reconstruction.