肝移植术后肝动脉假性动脉瘤四例报道

Hepatic artery pseudoaneurysm after orthotopic liver transplantation: report of 4 cases

目的总结肝移植术后肝动脉假性动脉瘤的发病情况、诊疗方法及预后。方法回顾性分析了2001年4月至2004年12月间肝移植术后发生的4例肝动脉假性动脉瘤患者可能的病因、诊断方法及处理原则。结果患者肝移植术后肝动脉假性动脉瘤破裂时间平均为21d(12～32d)。所有患者肝动脉假性动脉瘤均因破裂大出血均行剖腹探查,术中明确诊断。所有患者均有膈下积液,其中腹腔局部感染3例,真菌感染2例。合并胆漏1例。1例患者发生腹腔大出血3次,分别采用肝动脉重新吻合、移植物髂动脉搭桥、肝动脉结扎治疗;其余3例均采用供肝动脉结扎术。4例患者最终均因肝功能衰竭死亡。结论肝移植后发生肝动脉假性动脉瘤死亡率高,早期诊断困难,应针对病因进行预防。

Objective To review the incidence of hepatic artery pseudoaneurysms （PAs） and evaluate the therapeutic options and outcome of patients and grafts survival. Methods A retrospective review of patients undergoing orthotopic liver transplantation （OLT） in our institution from April 2001 to November 2004 was performed. A series of 4 cases of hepatic artery PAs were reported, attempting to identify the presentation of these patients, consider aetiological factors and examine the role of intervention in the management. Results Median time of hepatic artery PAs＇ rupture was 21 days post-transplant （range, 12-32 days）. All 4 patients were diagnosed as hepatic artery PAs rupture until laparotomies were performed owing to fatal intra-abdominal haemorrhage. All of them had subhepatic collections, with fungal organisms isolated in 2 patients and sepsis in 3 patients. One patient had a bile leak. One patient who presented with profound haemorrhage into the abdominal cavity thrice, underwent aneurysmectomy and re-anastomosis hepatic artery end-to-end, resection and revascularization with third party cadaveric lilac arterial graft and hepatic artery ligation successively. The other 3 patients underwent hepatic artery ligation. All 4 patients were died from liver function failure. Conclusion Because hepatic artery PAs is a high morbidity complication of liver transplantation and difficult to gain early diagnosis, preventive action on aetiological factors should be the first choice to decrease the morbidity.