儿童亲体部分肝移植术后肝动脉栓塞的防治

Prevention and treatment of hepatic artery thrombosis after living related liver transplantation in children

目的 探讨儿童亲体肝移植 (LRLT)术后肝动脉栓塞 (HAT)的预防和治疗。方法 5例Wilson’s病患儿行亲体部分肝移植 ,术中用显微外科技术吻合肝动脉 ;术后根据出凝血像结果 ,选用不同的血液制品 ,并予预防性抗凝治疗。结果 5例均健康存活。 1例术后曾发生HAT ,经急诊取栓并肝动脉重建术无效 ,再次肝移植后存活 (供肝为脑死亡者 )。结论 理想的肝动脉吻合、适当控制血制品和正确使用抗凝治疗是预防儿童LRLT和HAT的重要手段 ;一旦发生HAT应急诊取栓行肝动脉重建术 。

Objective To investigate prevention and treatment of hepatic artery thrombosis(HAT) post living related liver transplantation(LRLT)in children.Methods From January to June 2001,5 children with Wilsons disease were treated consecutively by LRLT.The donors were the patientsmothers.Special attention was paid to the following points:microsurgical technique in hepatic artery anastomosis;control of using various kinds of blood products and prophylactic anticoagulant therapy.Results Until now all 5 cases have survived and are in good condition.But one case developed HAT postoperatively.Since emergent thrombus removal with reanastomosis of hepatic artery ended with failure,retransplantation was required with a successful outcome.Conclusion Exquisitive technique of hepatic artery anastomosis,adequate application of blood products and accurate anticoagulation are the key points in the prevention and treatment of postoperative HAT.In case of occurrence of this complication,emergent thrombus removal with reanastomosis of hepatic artey or even liver retransplantation have to be considered.