肝移植中肝动脉重建及其并发症的处理  

Reconstruction of hepatic artery and management of its early thrombosis in liver transplantation:experiences from a single team of Eastern Hepatobiliary Surgery Hospital

作　　者：杨宁[1] 杨广顺[1] 卢军华[1] 张海斌[1] 李齐根[1] 王鑫[1] 司马辉[1] 邵卓[1] 

机构地区：[1]第二军医大学附属东方肝胆外科医院,上海200438

出　　处：《中国实用外科杂志》2008年第7期553-555,共3页Chinese Journal of Practical Surgery

基　　金：上海市科委重大项目<多种脏器移植的临床研究>;项目编号(024119001)

摘　　要：目的探讨肝移植术中肝动脉重建的手术技巧和肝动脉早期栓塞后的治疗选择。方法回顾性分析第二军医大学附属东方肝胆外科医院2003年4月至2006年3月159例次原位肝移植术和3例活体肝移植术中肝动脉重建的经验,比较不同口径的肝动脉吻合时间;早期动脉栓塞后施行介入溶栓治疗的效果。结果直径≥3mm动脉(120例)的平均吻合时间明显短于直径<3mm的动脉(42例,P<0.05);3例活体肝移植动脉重建时间分别是89min、120min和34min。2例(1.2%)术后早期并发肝动脉栓塞(HAT),1例介入溶栓治疗后肝动脉恢复血流,1例溶栓失败,急诊施行肝动脉-腹主动脉搭桥术后肝动脉恢复血流。结论小口径肝动脉重建难度大,活体肝移植应采用显微外科重建,合理的吻合技术可减少术后HAT的发生;早期HAT需合理选择治疗措施。Objective To explore the surgical techniques of hepatic： arterial reconstruction in liver transplantation and the therapeutic selection of its early thrombosis. Methods The clinical data of hepatic arterial reconstruetion based on 159 cases of cadveric donor liver transplantation and 3 cases of living-related liver transplantation peffomred from April 2003 to Mareh 2006 in the Eastern Hepatobiliary Surgery Hospital of Second Military Medical University were analyzed retrospectively. Anastomosis time was compared between two groups with different vaseular calibers. Early hepatic arterial thrombosis （HAT） was treated by means of interventional thrombolysis. Results Anastomosis for hepatic artery with less than 3mm in diameter （ n = 42, average time 33.6 ±21.3 min ）exhausted significantly more time in comparison with those with more than 3mm in diameter（ n = 120,average time 19.4 ± 7.4min）. For 3 cases of living-related liver transplantation,anastomosis time was 89min, 120min and 34min, respectively. Two cases （ 1.2% ） were complicated with early HAT. One case was successfully treated by thrombolysis,but the other- had to establish urgently a conduit between aorta and the graft following an attempting thrombolysis. Conclusion It exists more difficulties in the reconstruction of hepatic artery, with small caliber. It implicates that microsurgery should be applied for pediatric living-related liver transplantation. But adequate surgical teehniques could diminish the incidence of postoperative HAT, Effective therapeutic procedure needs to be carefully ehosen for individual early HAT.

关 键 词：肝动脉重建 肝移植 肝动脉栓塞 溶栓 

分 类 号：R6[医药卫生—外科学]