再次肝移植的肝动脉重建方法探讨(附15例报告)

Hepatic artery reconstruction in liver retransplantation:15 cases report

目的 探讨再次肝移植肝动脉重建的方法。方法 回顾15例再次肝移植的临床资料，分析肝动脉重建的不同方式。其中供体动脉与受体肝固有动脉与胃十二指肠动脉汇合部吻合重建4例（26．7％），与受体肝总动脉吻合重建4例（26．7％），与受体脾动脉吻合重建4例（26．7％），与受体腹主动脉架桥吻舍重建3例（19．9％）。结果 15例再次肝移植患者中11例（73．3％）术后顺利恢复，生存期1～22个月，中位生存期9个月。4例（26．7％）于术后早期死于感染性休克、多器官功能衰竭、急性心肌梗塞和颅内出血等并发症。所有患者术后肝动脉血流均正常，未出现血栓形成、肝动脉狭窄或假性动脉瘤等并发症。结论 再次肝移植肝动脉重建情况复杂，方式多样，根据供、受体肝动脉解剖的特点和首次移植时肝动脉的重建情况灵活选择适当的重建方式并进行细致的吻合，是再次肝移植肝动脉重建成功的关键。

Objective To investigate the techniques of hepatic artery reconstruction in liver retansplantation. Methods Fifteen cases of kiver rewansplantation were reviewed and the reconstruction of hepatic artery was analysed. Of the 15 cases, 4（26.7% ） recieved anastomosis of donor artery with recipient＇ s join of proper hepatic artery and gastroduodenal artery, 4 （ 26.7 % ） with recipient＇ s common hepatic artery, 4 （26.7 % ） with recipient＇ s splenic artery, and 3 （20.0 % ） with recipient＇s abdominal aorta bypass. Results Eleven of the 15 cases （73.3%） were cured and had survived for 1 - 22 months （midian 9 months） after hver retransplantation. The other4（26.7% ） died due to infectious shock, multiple organs failure, acute myocardial infarction, and intracranial hemorrhage. Blood flow of hepatic artery was normal in all cases postoperatively and no thrombosis, stenosis, pseudaneurysm or other hepatic artery comphcations occurred. Conclosion Hepatic artery reconstruction in liver retransplantation is complicated and the operation manner is multiplicated. To select an appropriate reconstruction manner, careful anastomosis is the key to the successful reconstruction of hepatic artery according to the anatomic characteristics of both donor and recipient＇ s hepatic arteries and the information of the reconstruction in the first transplantation.