肝移植中肝动脉相关并发症的处理与结局

Management of hepatic artery related complications and its outcome during liver transplantation

目的:探讨肝移植中肝动脉相关并发症处理的经验和结局。方法:回顾性总结2001年5月至2009年5月期间北京大学人民医院肝胆外科实施的570例肝移植患者的临床资料,总结肝动脉重建的技术要点及其并发症的处理经验。结果:570例肝移植患者中发生肝动脉相关并发症者共18例,发生率为3.1%,其中11例肝动脉血栓形成、5例肝动脉吻合口狭窄、2例肝动脉吻合口破裂出血。18例中死亡11例,死亡率61.1%,其中,11例肝动脉血栓形成的患者中死亡7例,5例肝动脉吻合口狭窄的患者中死亡2例,2例肝动脉吻合口破裂出血的患者均死亡。11例死亡患者中,5例死于急性肝坏死或胆瘘引起的严重全身感染,4例死于胆道并发症和肝功能衰竭,2例死于肝动脉吻合口破裂出血。结论:保证供肝动脉的质量、选择恰当的肝动脉重建技术是肝移植中预防肝动脉相关并发症的关键,早发现、早诊断以及早期积极的溶栓、介入或再行肝移植治疗可改善移植物和患者的预后。

Objective：To explore the experience of hepatic arterial reconstruction and management of its complications. Methods： The clinical data of 570 consecutive orthotopic liver transplantation patients performed from May 2001 to May 2009 in Peking University People’s Hospital were analyzed retrospectively in order to summarize the key factors of hepatic arterial reconstruction and the experience of management of its complications. Results： Arterial complications developed in 18（3.1%） of the 570 patients including 11 cases of hepatic artery thrombosis,5 cases of hepatic artery stenosis and 2 cases of hepatic artery rupture. Of the 11 cases with early complication（within 4 weeks）,7 patients died,including 2 due to the rupture of hepatic artery and 5 due to acute liver failure and sepsis of hepatic artery thrombosis. Of the 7 cases with late compication,4 patients died,including 1 due to graft failure and 3 due to ischemic-type biliary complications. Conclusion： Good quality of donor artery and proper choice of microsurgical anastomosis technique in hepatic artery reconstruction could significantly reduce the incidence of its complication. Early detection and diagnosis with active early interventional therapy can improve prognosis of the patients.