20例再次肝移植血管重建的方法

Vascular reconstruction in liver retransplantation： a report of 20 cases

目的探讨再次肝移植血管重建的方法。方法回顾20例再次肝移植的临床资料，分析血管重建的不同方式。结果20例再次肝移植病人术后随访期2d至25个月，平均11．2个月。其中15例（75％）术后顺利恢复，至今存活。5例（25％）于术后早期死于感染性休克、多器官功能衰竭、急性心肌梗死和颅内出血等并发症。所有病人术后肝动脉、门静脉、肝静脉流出道血流均正常，未出现血管破裂、血栓形成、血管狭窄和梗阻或假性动脉瘤等明显血管并发症。结论再次肝移植血管重建情况复杂，方式多变，根据供、受体血管的解剖特点和首次移植时血管重建的情况灵活选择适当的重建方式并进行细致的吻合，是再次肝移植血管重建成功的关键。

Objective To investigate the techniques of vascular reconstruction in liver retransplantation. Methods The clinical data of 20 patients receiving liver retransplantation in our hospital were retrospectively analyzed to determine the different types of vascular reconstruction. Results All the 20 patients had been followed up for 2 d to 25 months （mean=11.2 months） and 15 （75%） were cured and have survived till now after liver retransplantation. The other 5 patients （25%） died due to infectious shock, multi-organ failure, acute myocardial infarction and encephalic hemorrhage. The blood flow of hepatic artery, portal vein; hepatic vein and vena cava was normal and no rupture, thrombosis, stenosis, obstruction, pseudaneurysm or vascular complications occurred after the liver retransplantation. Conclusions Vascular reconstruction in liver retransplantation is complicated and the operation manner is various. To select an appropriate reconstruction manner with careful anastomosis according to the anatomic features of both donor and recipient＇s blood vessels and the information of vascular reconstruction in the first liver transplantation is important for success of vascular reconstruction in the liver retransplantation.