原位肝移植中受体血管异常时的肝动脉重建

Reconstruction of heptic artery for vascular anomalies of recipient in orthotopic liver transplantation

目的 探讨原位肝移植中动脉异位重建的方法及效果。方法 回顾性分析我院 1 0年来的 4 4 0例肝移植中 3 6例因受体血管异常而行异位重建的方法及术后处理措施等。结果 3 6例中行供肝动脉与受体肾下腹主动脉吻合 2 0例,与肾上腹主动脉吻合 1 0例,与胃左动脉吻合 4例,与脾动脉吻合 2例。 5例围手术期死亡,但吻合口通畅, 3 1例存活 3个月至 4年无血管相关并发症,仅 1例术后 2个月因胆道缺血坏死行再次肝移植。结论 肝移植时受体肝动脉有病变或异常改变时,应将受体肾下或肾上腹主动脉、脾动脉、胃左动脉与供肝动脉进行异位重建,可取得满意效果。

Objective To investigate the methods and effectiveness of heterotopic reconstruetion of hepatic artery in orthotopic liver transplantation. Methods The methods of heterotopic hepatic artery reconstruction and postoperative management of 36 cases of recipient vascular anomalies among 440 cases of liver transplantation performed in our hospital over a ten year period,were retospectively analysed. Results In 10 of 36 recipients the donor hepatic artery was anastomosed to recipient infrarenal aorta ,10 to the suprarenal aorta ,4 to the left gastric artery and 2 to the splenic artery. Five patients died perioperatively with patency of hepatic artery, and 31 recipients have survived for 3 to 48 months without hepatic artery complications; 1 patient had to receive liver retransplantation because of ischemic necrosis of bile duct. Conclusions In cases of disease or anomaly of recipient hepatic artery during liver transplantation,the heterotopic reconstruction of donor hepatic artery to the infarenal or suprarenal aorta,splenic artery or left gastric artery of the reeipient is indicated,and the results are satisfactory.