应用供者髂动脉行腹主动脉搭桥重建移植肝动脉的临床分析

Hepatic artery reconstruction using donor′s iliac artery through abdominal aorta bypass graft in orthotopic liver transplantation

目的探讨应用供者髂动脉行腹主动脉搭桥重建移植肝动脉对肝移植受者预后的影响。方法回顾性分析中国医科大学附属第一医院2006年1月至2018年4月应用供者髂动脉行腹主动脉搭桥重建肝动脉的肝移植受者临床资料,观察其术后肝功能恢复情况及肝动脉血栓等并发症的发生情况,分析采用搭桥方式进行移植肝动脉重建的原因。结果共纳入8例受者,其中1例存在脾动脉盗血综合征导致肝总动脉供血不足,3例肝总动脉纤细,4例肝总动脉壁薄弱或分层。重建后肝动脉平均血流为(315±178)mL/min。术后2例受者分别因肝脏流出道和胆管吻合口狭窄导致黄疸,其余受者移植肝功能恢复良好。1例受者术后2个月出现肝动脉血栓形成,继发肝脓肿,半年后因多脏器功能衰竭死亡。其余7例受者随访至2018年11月均存活,肝动脉均通畅,无狭窄或血栓形成。结论当供、受者常规肝动脉端端吻合无法实施时,应用供者髂动脉行腹主动脉搭桥重建移植肝动脉是一种可行的肝动脉重建方法。

Objective To discuss the clinical effect of hepatic artery reconstruction using donor′s iliac artery through abdominal aorta bypass graft in orthotopic liver transplantation. Methods The clinical data of liver transplantation recipients who got hepatic artery reconstruction using donor′s iliac artery through abdominal aorta bypass graft from January 2006 to April 2018 in the First Hospital, China Medical University, were retrospectively analyzed. The observation indexes included recovery of liver function and occurrence of complication like hepatic artery thrombosis. Trying to find what types of liver transplantation recipients should receive hepatic artery reconstruction. Results Eight recipients were incorporated into study, including 1 recipient with common hepatic artery hypoperfusion because of splenic artery steal syndrome, 3 recipients with slim common hepatic artery, and 4 recipients with weak or stratified common hepatic artery wall. The mean blood flow of the reconstructed hepatic artery was (315±178) mL/min. Except for 2 recipients with jaundice due to stenosis of the hepatic outflow tract and bile duct anastomosis, the liver function of other recipients recovered well. One recipient was diagnosed as hepatic artery thrombosis 2 months after transplantation, and then developed liver abscess and died of multiple organ failure half a year later. The rest of the recipients still alive and no hemadostenosis and thrombosis were found up to November 2018. Conclusions When conventional anastomosis of donor and recipient hepatic artery can not be performed, using donor′s iliac artery to reconstruct the hepatic artery of recipient through abdominal aorta bypass graft can be considered.