肝移植术肝动脉重建问题(附17例报告)

The Problems of Reconstruction of Hepatic Artery in Liver Transplantation (a Report of 17 Patients)

目的:探讨肝移植术肝动脉的重建问题。方法:回顾分析自2003年7月-2004年12月,16例原位肝移植和1例小儿活体肝移植,分析肝动脉变异,血管吻合技术及术中、术后应用凝血因子和止血药物的影响。结果:17例供肝中有2例肝动脉变异。肝动脉内径>3 mm(n=11),内径<3 mm(n=6)。肝动脉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、纤维蛋白原等凝血因子,术后定期彩色多普勒超声检测均未发现肝动脉血栓形成,1例小儿肝移植采用 DSA检查发现供受体肝动脉细小。结论:原位肝移植中供肝的肝动脉变异较多见,修剪肝动脉时应加以注意,避免误伤; 正确采用血管外科显微技术,可明显减少肝动脉并发症的发生;适当应用凝血因子、止血药物安全有效,不增加肝动脉血栓形成等并发症。

Objective： To explore the problems of reconstruction of hepatic artery（HA） in liver transplantation. Methods：Variation of the hepatic artery, techniques of reconstructions of HA and the effect of coagulant factors and hemostasis drugs on influence of HA in 16 cases of cadveric donor liver froms plantation and 1 case of pediatric living-related liver transplantation from July 2003 to December 2004 were restrospectively analyzed in this article. Results： In this guoup,2 were found variation with HA. Microsurgical vascular technigues（MVT） was put to use in reconstriction of HA. 5 were treated with thrombinogen complex,fibrinogen during and after operation. The thrombosis in the HA were not found by detection via Doppler ultrasonic after operation. Conclusion：Variation of HA are familiar in cadveric donor liver froms transplantation. BE careful during manicuring the HA to avoid impairing it. It may evidently diminish the incidence of the complications of HA by using MVT. It is effective and safe to use coagulant factors and hemostasis drugs appropriately. It may not increase the incidence of therombosis in the HA.