原位肝移植肝动脉血栓形成的预防和治疗

目的 总结原位肝移植肝动脉重建及其并发症的防治经验，以提高肝移植疗效和受体存活率。方法 分析9年间实施的85例原位肝移植患者的临床资料。肝动脉重建采用供者腹腔动脉干Carrell’s袖片或肝总动脉-脾动脉汇合部与受者肝左-右动脉部吻合16例(18．82％)，与受者胃十二指肠-肝固有动脉汇合部吻合61例(71．76％)，采用髂动脉-腹主动脉搭桥8例(9．42％)。术后根据凝血酶原时间(PT)，使用普通肝素或低分子肝素预防性抗凝。术中、术后应用多普勒超声监测肝动脉血供。结果 1例术中发生肝动脉血栓形成(HAT)，立即行血栓切除，重新吻合动脉，现已随访13个月，肝动脉保持通畅。其余84例随访2～54个月，未见HAT发生。全组HAT发生率为1．2％。结论 正确选择肝动脉重建吻合的部位和术后有效的抗凝治疗可以减少HAT的发生；多普勒超声监测能早期发现HAT，挽救移植物，避免再移植。

Prevention and management of hepatic artery thrombosis in orthotopic liver transplantation

ObjectiveTo investigate the methods of hepatic arterial reconstruction in orthotopic liver (transplantation)(OLT), and the prevention and management of associated complications, so as to improve the therapeatic results and donor survival rate of OLT.MethodsThe clinical data of 85 cases of orthotopic liver transplantation performed in our institute from May 1995 to May 2004 were retrospectively analysed. Hepatic artery reconstruction was made by use of Carrels patch of donor celiac artery or bifurcation of donor common hepatic artery and splenic artery anastoniosed to left and right hepatic artery of recipient in 16 cases((18.82)%), to bifurcation of gastroduodenal and proper hepatic arteries of recipient in 61 cases((71.76)%), or use of donor iliac artery interposition graft to abdominal aorta in 8 cases(9.42%). Regular heparin or low-molecular-weight heparin as a prophylactic anticoagulation therapy was maintained during and after (operation) as indicated by prothrombin time. Intra-and postoperative Doppler ultrasonography was used to (monitor) hepatic arterial blood supply.ResultsHepatic artery thrombosis(HAT) was observed in 1 case (intraoperatively)(overall incidence 1.2%).Thrombectomy and reconstruction of the arterial anastomosis were performed immediately.This patient currently has a survival time of 13 months without HAT. HAT was not observed in any of the other 84 cases during the follow up of 2 to 52 months.Conclusions Hepatic artery thrombosis may be minimized by proper selection of anastomotic site of hepatic artery reconstruction and (effective) use of postoperative anticoagulation.Close follow-up by Doppler ultrasonography may make a prompt diagnosis of HAT, salvage grafts and avoid re-transplantation.