分支补片在28例肝移植肝动脉重建中的应用

Application of Branch Patch in Hepatic Artery Reconstruction of 28 Cases of Liver Transplantation

介绍在肝移植肝动脉重建中,避免因吻合肝动脉口径相差过大,造成内膜损伤、术后狭窄和血栓形成的方法。方法:利用分支补片技术,将供肝肝总动脉和胃十二指肠动脉分叉处,修整成肝固有动脉补片。将受体肝固有动脉和胃十二指肠动脉分叉处,修整成肝总动脉补片,相吻合重建肝动脉。结果:在28例肝移植肝动脉重建中均一次吻合成功,术后随访1～12个月,经多普勒超声监测,管腔通畅,血流速正常。3例发生高流速、高阻力,肝穿刺活检证实为排异反应,应用甲基强的松龙冲击治疗缓解,血流速恢复正常。结论:本方法解决了吻合血管之间口径相差过大,易致吻合后吻合口缩窄的问题,加大了吻合口处口径,延长了动脉,减低了吻合口张力。出血极少,明显缩短了手术时间。

To introduce the application of branch patch in hepatic artery reconstruction of 28 cases of liver transplantation . Methods: The proper hepatic patch was made with the bifurcation of common hepatic and gastroduodenal arteries in donors , and the common hepatic branch patch was utilized with the bifurcation of the proper hepatic and gastroduodenal arteries in recipients.Then,the two patches were anastomosed to reconstruct the hepatic artery. All cases were followed up from 1 to 12 months with Doppler ultrasonography after operation. Results: The patent lumen and normal blood flow speed occurred in 25 cases,and the high flow speed and high resistance occurred in other 3 cases. This high flow speed returned to normal level after methylprednisolone impact treatment. Conclusion: This method may resolve the problem of the difference between the calibers of anastomosed arteries and decrease the tension of the arteries and bleeding. The operating time is also shortened significantly.