原位肝移植术后肝动脉并发症的预防及处理策略  

Prevention and management of hepatic arterial complications after orthotopic liver transplantation

作　　者：马毅[1] 王国栋[1] 王东平[1] 鞠卫强[1] 巫林伟[1] 胡安斌[1] 朱晓峰[1] 何晓顺[1] 

机构地区：[1]中山大学附属第一医院器官移植中心,广东广州510080

出　　处：《中国实用外科杂志》2006年第12期955-957,共3页Chinese Journal of Practical Surgery

摘　　要：目的探讨肝移植术后肝动脉并发症的危险因素以及肝动脉并发症的预防和治疗手段。方法回顾性分析2004年中山大学附属第一医院实施的181例同种原位肝移植病人的临床资料。结果181例肝移植病人中与动脉相关的并发症共12例,发生率为6·6%(12/181);术后近期发生的7例动脉相关并发症中,5例为动脉血栓形成,2例为误伤右副肝动脉而继发的大面积肝坏死;术后远期发生的5例动脉相关并发症中,动脉血栓形成2例和动脉广泛狭窄3例。所有12例与动脉相关的并发症中,接受再次肝脏移植者7例,3例行急诊肝动脉取栓术并重建肝动脉血流;2例进行溶栓治疗。因肝动脉并发症导致死亡6例,占该组肝移植病人死亡的28·6%(6/21)。结论显微外科技术在肝动脉吻合中的应用以及预防或及时纠正血液高凝状态,可以降低动脉并发症的发生率。肝动脉相关并发症的处理应采用个体化治疗方案,再血管化手术或再次肝移植是治疗肝动脉并发症的最常用方案。对已估计到即使行再动脉化术后肝功能也不能逆转的病人,应积极准备再次肝移植,且应在移植肝功能衰竭和严重感染出现之前进行。Objective To investigate the risk factors, prevention and management of hepatic arterial complications after liver transplantation. Methods Clinical data of 181 cases of allograft orthotopic liver transplantation admitted in 2004 in First Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. Results Among 181 cases, 12 cases were related to arterial complications with incidence rate of 6.6% （ 12/181 ）. Among 7 cases of arterial complications occurred in short term after operations, arterial thrombosis occurred in 5 cases and large area hepatic necrosis result from injury of right accessory hepatic artery by mistake occurred in 2 cases. Among 5 cases of arterial complications occurred in long term after operations, arterial thrombosis occurred in 2 cases and hepatic artery stenosis occurred in 3 cases. Among 12 cases of aterial related complications, 7 cases underwent another liver transplantation ; 3 cases underwent emergency thrombolectomy and hepatic artery reconstruction ;2 cases underwent thrombolysis treatment. Six cases died resulted from hepatic arterial complications, which accounted for 28.6% （6/21） of dead cases after liver transplantation. Conclusion Application of microsurgical techiniques in hepatic arterial anastomosis, prophylasis and rectification of blood hypercoagulabale state are the important factors to decrease arterial complication incidence rate. Individualized therapeutic regimen should be applied to treat the complications related to artery and the revascularization or liver retransplantation are the main common regimen. Patients with severe liver functional lesion and low probability to reverse should be performed retransplantation and surgery should be performed before the appearance of liver function failure and severe infection.

关 键 词：肝移植 肝动脉 血栓形成 

分 类 号：R6[医药卫生—外科学]