摘要
目的探讨供肝肝动脉解剖变异的整形重建方式及对移植后肝动脉血栓形成(HAT)、胆道并发症及移植疗效的影响。方法回顾性分析1999年5月至2005年9月完成的330例原位肝移植临床资料。应用显微外科技术对变异肝动脉进行整形。供肝肝动脉整形、重建及供受者间动脉的吻合在2.5倍放大镜下以7-0、8-0 Prolene或Vascufil缝线完成。术后每日用多普勒超声检查肝动脉血流1周,其后定期监测。结果67例供肝肝动脉存在解剖变异,占20.5%(67/327),实施血管重建性吻合79例次。存在动脉变异供肝附加血管整形重建组围手术期HAT发生率与无肝动脉变异供肝肝移植组围手术期HAT发生率比较(1.5%vs1.15%);随访期内胆道并发症发生率与无肝动脉变异供肝肝移植组发生率比较(9.0%vs7.7%),均无显著差异(P>0.05)。两组受者比较,1、3年生存率无显著差异(91.3%vs90.7%,86.7%vs88.2%)(P>0.05)。结论应用存在肝动脉变异并血管整形的供肝,实施肝移植不增加HAT及胆道并发症发生率,并可取得与无变异肝动脉供肝相同的远期疗效。
Objective To investigate the methods of hepatic artery （HA） reconstruction in donors with HA anatomic variations and their effects on hepatic artery thrombosis （ HAT）, biliary complication and patients＇ survival in orthotopic liver transplantation （OLT）. Methods A retrospective analysis was applied in 330 liver transplantations （LTx） performed between May 1999 and September 2005. Arterial reconstruction was performed by microsurgical techniques with continuous or interrupted 7-0, 8 0 monofilament Prolene or Vascufil sutures under 2.5X loupe magnification. The graft arterial flow was detected by Doppler ultrasound daily in the first postoperative week and periodically thereafter. Results Sixty seven of 327 （20.5%） liver allografts had hepatic artery anatomical variations, and reconstructive anastomosis was performed in 79 cases. No significant difference was found in the incidence of HAT during perioperative period and in biliary complications during follow-up period between recipients with complex hepatic artery reconstruction and those with simple arterial reconstruction （1.5% vs 1.15%, 9.0% vs 7.7%）（P〉0.05）. No significant difference were found in the overall 1- , 3-year patient survival rates in the two groups （91.3% vs 90.7%, 86.7% vs 88.2%）（P〉0.05）. Conclusions The variations of hepatic arteries in donors are common, and complex hepatic reconstruction does not influence the incidence of HAT and biliary complications, and the long-term outcome after OLT.
出处
《消化外科》
CSCD
2006年第1期23-25,共3页
Journal of Digestive Surgery
关键词
肝移植
肝动脉
解剖变异
肝动脉重建
liver transplantation
hepatic artery
anatomical variation
hepatic artery reconstruction
