肝移植术肝动脉栓塞的原因及血管重建的方式

目的　分析肝移植术中和术后肝动脉栓塞(hepaticarterythrombosis,HAT)的原因,并探讨不同血管重建方式的效果。　方法　回顾性总结Pittssburgh大学器官移植中心和南京大学附属鼓楼医院共21例肝移植术中、术后HAT,其中12例(57. 1% )施行了肝动脉重建术(hepaticarteryreconstruction,HAR)。HAR方法有直接吻合(4例)、供体肝动脉-受体腹主动脉架桥术(aortohepaticinterpositiongraft,AHIG) (6例)、髂动脉架桥术(interpositiongraft,IG) (2例)。　结果　肝动脉血流重建成功率为58. 3% (7 /12);其余5例平均3. 8(3~6)d内再次发生HAT。成人HAR成功率为62. 5% (5 /8),儿童为50. 0% (2 /4)。HAR结果与HAT发生时间、HAT原因和HAR方式无明显相关性(P>0. 05)。　结论　肝移植术HAT可能原因有机械因素、受体肝动脉细小、供体肝动脉感染、供体DIC等,尽量减少或避免上述危险因素是最好的预防方法。肝移植术HAT时HAR方式包括直接吻合、AHIG、IG等,成功取决于能否及时获得诊断。有趋势表明机械因素所致HAT,HAR方式采用直接吻合和AHIG有较好的临床结果。

Causes of Hepatic Artery Thrombosis and Vascular Reconstruction after Orthotopic Liver Transplantation

Objective To analyze the causes and reconstructive effect of intraoperative or postoperative hepatic artery thrombosis(HAT) in orthotopic liver transplantation. Methods Of 21 grafts with HAT,12(57.1%,6 intraoperative and 6 postoperative) underwent reconstruction of the hepatic artery. Methods of HAR included revision of an astomosis (4 cases),placement of AHIG(6 cases)and placement of IG between donor and recipient artery(2 cases). Results The arterial flow was reestablished and maintained in 7(58.3%) of the 12 cases. Recurrent thrombosis in the other 5 grafts developed 3 to 6 days (mean 3.8 days) after HAR. Reconstruction was in 62.5%(5/8) of the adults, compared with only 50%(2/4) of children. No obvious relationship is observed between the outcome of HAR and the timing or the causes of HAT or methods of HAR( P >0.05). Conclusions The possible causes of HAT among these patients included mechanical causes (anastomosis stricture,rotation of the hepatic artery (HA), intimal dissection of recipient HA, infected donor HA, DIC in donor. The best way of prevention of HAT is to reduce or avoid these risk factors as much as possible. Methods of HAR included anastomosis, AHIG, IG and so on. Successful HAR in this series seems to demonstrate the importance of early detection of the HAR. Grafts with HAT due to mechanical causes responds well to HAR and revision of anastomosis and AHIG present good results.