摘要
目的总结成人间活体肝移植(adult-to-adult living donor liver transplantation,A-A LDLT)肝动脉重建并发症的预防经验。方法总结2002年1月-2008年3月收治的127例A-A LDLT临床资料,分析肝动脉重建并发症的预防。131例供体中(移植右半肝127例,移植左半肝4例),男69例,女62例;年龄19～65岁,平均36.2岁。127例受体中男109例,女18例;年龄18～64岁,平均41.9岁。62例供体右肝动脉与受体右肝动脉吻合,34例与受体肝固有动脉吻合,7例与受体左肝动脉吻合,6例与受体肝总动脉吻合,8例与受体肠系膜上动脉发出的副右肝动脉吻合,5例与受体肝总动脉自体大隐静脉间搭桥,2例受体腹主动脉与供体右肝动脉自体大隐静脉搭桥,3例用尸体冷冻保存髂血管行受体腹主动脉与供体右肝动脉搭桥。结果术后1、7d,发生肝动脉血栓形成2例(1.6%),采用自体大隐静脉、肾下腹主动脉至供体右肝动脉搭桥术后痊愈;1例于术后46d发生肝动脉血栓形成,无临床症状未予处理。术后及随访期未发现肝动脉狭窄、肝动脉假性动脉瘤等并发症。围手术期无与肝动脉并发症有关的死亡患者。患者均获随访,随访时间9～67个月,术后1、2、3年实际生存率分别为82.2%、64.7%和59.2%。结论供、受体肝动脉解剖变异,受体肝动脉病理改变,以及肝动脉血管吻合技术是肝动脉重建并发症发生的重要影响因素。
Objective To summarize the experience of the prevention of early arterial complications after hepatic artery（HA） reconstruction in adult-to-adult living donor liver transplantation（A-A LDLT）.Methods Between January 2002 and March 2008,127 patients underwent A-A LDLT.Of the 131 donors（127 cases of right lobe graft,4 cases of left lobe graft）,there were 69 males and 62 females with a mean age of 36.2 years（range,19-65 years）;in 127 recipients,there were 109 males and 18 females with a mean age of 41.9 years（range,18-64 years）.All patients underwent microsurgical reconstruction of HA between grafts and recipients.The artery of graft was anastomosed to the right HA in 62 cases,to the proper HA in 34 cases,to the left HA in 7 cases,to the common HA in 6 cases,and aberrant right HA rising from superior mesenteric artery in 8 cases.Interposition bypass using great saphenous vein（GSV） was performed between the donor right HA and recipient common HA in 5 cases.Bypass was performed between the donor right HA and recipient abdominal aorta using GSV in 2 cases,or using cryopreserved cadaveric iliac vessels in 3 cases.Results Of these 127 cases,hepatic artery thrombosis（HAT） occurred in 2 recipients（1.6%） at 1 day and 7 days following A-A LDLT,which were successfully revascularized with GSV between right HA of donor and abdominal aorta of recipient,HAT in 1 patient occurred on the 46th postoperative day with no symptom.No other arterial complication such as HA stenosis and aneurysm occurred in recipients.All patients were followed up 9-67 months.At 1,2,and 3 years,actual survival rates were 82.2%,64.7%,and 59.2%.No death was related to HA complication in peri-operative period.Conclusion The anatomic structure and variation of HA,the pathological changes,as well as surgical technique in HA reconstruction,have direct impact on the risk of postoperative complications of HA reconstruction.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2011年第4期498-501,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
活体肝移植
成人间
肝动脉重建
并发症
Living donor liver transplantation Adult-to-adult Hepatic artery reconstruction Complication
