原位肝移植的血管重建问题(附12例报告)

The problems of vascular reconstruction in orthotopic liver transplantation:Report of 12 cases

目的 探讨原位肝移植的血管重建问题。方法 回顾性分析我院近 8个月来所施行的 12例原位肝移植 ,探讨其血管变异问题 ,血管吻合技术及术中、术后应用凝血因子和止血药物的效果。结果 12例供肝中有 2例肝动脉变异。血管吻合采用血管外科显微技术 ,5例术中术后应用凝血酶原复合物、纤维蛋白原等补充凝血因子 ,全组术后彩色多普勒超声检测均未发现肝动脉、门静脉血栓形成等血管并发症。结论 原位肝移植中供肝的肝动脉变异是比较多见的 ,修剪肝动脉时应加以注意 ,避免误伤 ;血管吻合应坚持采用血管外科显微技术 ,可明显减少血管并发症的发生 ;适当应用凝血因子、止血药物是安全有效的 ,不会增加肝动脉、门静脉血栓形成等并发症。

Objective To discuss the problems of vascular reconstruction in orthotopic liver transplantation(OLC).Methods vascular variation,vascular inosculation and the effect of coagulant factors and hemostasis durg on vascular complications in 12 patients of OLT operated in our hospital in recent 8 months were restrospectively analyzed in this article.Results Of the 12 patients,two were found variation with liver artery.Microsurgical vascular technology was put to use in vascular inosculations.Five were treated with thrombinogen complex,fibrinogen during and after operation.Vascular complications,e.g.thrombosis in the liver artery and portal vein were not found by detection via Doppler ultrasonic after operation.Conclusion Variation of liver artery are familiar in OLT providers.Be careful during manicuring the liver artery to avoid impairing it.It may evidently reduce the incidence of the vascular complications by using microsurgical vascular technology to inosculate vascular.It is effective and safe to use coagulant factors and hemostasis drugs appropriately.It may not increase the incidence of therombosis in the liver artery and portal vein.