解剖性肝动脉重建在肝移植中的应用价值  

Application value of anatomical hepatic artery reconstruction in liver transplantation

作　　者：郭亚飞 刘国岩 朱泽斌 栗雪峰 吴维 黄德好 刘连新 Guo Yafei;Liu Guoyan;Zhu Zebin;Li Xuefeng;Wu Wei;Huang Dehao;Liu Lianxin(Organ Transplantation Center,the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,China;Department of Ultrasound,Southern District,the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)器官移植中心,合肥230001 [2]中国科学技术大学附属第一医院(安徽省立医院)南区超声科,合肥230001

出　　处：《中华肝脏外科手术学电子杂志》2021年第4期376-380,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：2019年度“科大新医学”联合基金(WK9110000055)。

摘　　要：目的探讨解剖性肝动脉重建在肝移植中的应用价值。方法回顾性分析2017年4月至2019年12月在中国科学技术大学附属第一医院接受原位肝移植的50例患者临床资料。其中男37例,女13例;平均年龄(46±9)岁;供肝均来源于公民逝世后器官捐献。患者均签署知情同意书,符合医学伦理学规定。按不同动脉重建方式将患者分为解剖性肝动脉端侧吻合组(端侧组,16例)和端端吻合组(端端组,34例)。端侧组保留受体胃十二指肠动脉。比较两组术后1周内超声下肝动脉峰值流速(PSV)、阻力指数(RI)、术后肝动脉及胆道并发症发生情况。两组PSV等比较采用t检验,率的比较采用χ^(2)检验。结果端侧组术后1周PSV为(43±24)cm/s,明显低于端端组的(62±30)cm/s(t=-2.301,P<0.05)。端侧组术后RI为0.51±0.26,端端组为0.64±0.15,差异无统计学意义(t=1.758,P>0.05)。端侧组术后发生并发症3例,其中肝动脉并发症1例,胆道并发症2例;端端组8例,其中肝动脉并发症2例,胆道并发症6例,差异无统计学意义(χ^(2)=0.145,P>0.05)。结论解剖性肝动脉重建保留受体胃十二指肠动脉,符合解剖生理及重建要求,血流动力学方面优于传统重建方式,可作为肝移植术一种新的动脉重建方式供选择。Objective To evaluate the application value of anatomical hepatic artery reconstruction in liver transplantation.Methods Clinical data of 50 patients who underwent orthotopic liver transplantation in the First Affiliated Hospital of University of Science and Technology of China from April 2017 to December 2019 were retrospectively analyzed.Among them,37 patients were male and 13 female,aged(46±9)years on average.All donor livers were obtained from organ donation after death of citizen.The informed consents of all patients were obtained and the local ethical committee approval was received.All patients were divided into the anatomical hepatic artery end-toside anastomosis group(end-to-side group,n=16)and end-to-end anastomosis group(end-to-end group,n=34)according to different artery reconstructions.The gastroduodenal artery of the recipients was preserved in the end-to-side group.The peak systolic velocity(PSV)of hepatic artery,resistance index(RI)1 week after operation and the incidence of postoperative complications of hepatic artery and biliary tract were statistically compared between two groups.Comparison of the PSV between two groups was conducted by t test.The rate comparison was performed by using Chi-square test.Results In the end-to-side group,the PSV at postoperative 1 week was(43±24)cm/s,significantly lower than(62±30)cm/s in the end-to-end group(t=-2.301,P<0.05).In the end-to-side group,postoperative RI was 0.51±0.26,which did not differ from 0.64±0.15 in the end-to-end group(t=1.758,P>0.05).In the end-to-side group,3 patients developed postoperative complications,including 1 case of hepatic artery complication and 2 cases of biliary complications.In the end-to-end group,8 cases presented with postoperative complications,including 2 cases of hepatic artery complications and 6 cases of biliary complications.No statistical significance was observed between two groups(χ^(2)=0.145,P>0.05).Conclusions Anatomical hepatic artery reconstruction preserves the gastroduodenal artery of receipient,which me

关 键 词：肝移植 肝动脉重建 手术后并发症 

分 类 号：R657.3[医药卫生—外科学]