活体肝移植肝动脉重建技术与并发症

Microsurgical technique in reconstruction of hepatic artery in living donor liver transplantation

目的 探讨活体肝移植中肝动脉重建的显微外科技术 ,以降低肝动脉栓塞的发生率 ,提高患者移植后的生存率。方法 本组 2 4例 ,其中右半肝活体肝移植 6例 ,左半肝移植 16例 ,左外叶 2例 ;采用显微外科技术行肝动脉吻合。吻合的方式是端端吻合。结果 11例肝动脉直径<2mm ,重建肝动脉时间为 2 4～ 88min。行单支动脉吻合 2 0例 ,两支动脉吻合 4例 ;2例患者术后出现肝动脉血栓形成 ,均须行再次肝移植后恢复。本组肝动脉血栓的发生率为 8 3%。

Objective Hepatic arterial reconstruction is one of the most difficult procedures in living-donor liver transplantation (LDLT).If hepatic artery thrombosis (HAT)occurs after liver transplantation,the recipient clinical prognosis will be unevenful.The aim of this study was to explore the experience of the microsurgical technique in the reconstruction of hepatic artery.The introduction of microvascular hepatic arterial reconstruction has significantly decreased the incidence of HAT.Methods From Sep 2000 to Jun 2001,we performed 24 cases of living donor liver transplantation.Hepatic arterial reconstruction was performed under microscopic guidance.The fashion of arterial reconstruction is end-to-end anastomosis.Results The graft arteries in 11 cases were less than 2 mm in diameter.The time required for an arterial reconstruction was 24-88 min.HATs were recognized in 2 cases(8.3%),both of which needed retransplantation.Conclusions The microsurgical technique in reconstruction of hepatic artery can improve the surgical outcome,not only in orthotopic liver transplantation but also in living donor liver transplantation.