摘要
目的 分析 10例活体肝移植术中的血管变异 ,总结其外科处理经验 ,进一步提高手术成功率 ,减少并发症。方法 2 0 0 1年 1月至 12月 ,行活体肝移植 10例 ,其中左半肝 8例 ,左外叶 1例 ,右半肝 1例 ,供肝者均为其母 ,经术中B超及胆管造影以确定肝切线。供体单支肝动脉分支与受体肝动脉吻合 ,两支肝动脉分别与受体肝左、右动脉吻合。门静脉分支与受体门静脉主干吻合。供体肝静脉与受体下腔静脉行端侧吻合。胆管重建均采用肝管分支与受体胆总管端端吻合 ,置T管引流。结果 10例活体肝移植 ,1例因肝动脉血栓形成 ,术后 5天需再次肝移植 ;1例发生排斥 ;其余 8例均康复出院 ,5例已上学。结论 活体肝移植术中血管重建技术是其重要环节 ,术前和术中了解供受体解剖变异并正确处理 ,可减少术后血管和胆道的并发症。
Objective To analyze the vascular anatomical variations of encountered in living donor liver transplantation(LDLT) and summarize the experience of surgical management. Methods From Jan to Dec 2001, 10 case of LDLT have been performed,including 8 case of left lobe of liver,1 case of left lateral lobe and 1 case of right lobe of liver.All the donors were the patients' mothers.The liver transection line was decided by B-mode ultrasound and cholangiography in the operation.Arterial anastomoses were generally between the donor left or right hepatic artery and the recipient main hepatic artery. Double donor arteries were joined to the bifurcation of the recipient hepatic artery. The branches of donor portal vein were anastomosed to the recipient main portal vein. Hepatic veins were anastomosed to the recipient inferior vena cava.end-to-end anastomosis was wsed in all biliary reanstruction, performed over a T tube. Results In the 10 cases of LDLT,one case was hepatic artery thrombosis, needed retransplantation after 5 days of operation.Rejection occurred in one case. Other 8 cases have been discharged from hospital, and five children have gone to school. Conclusion Vascular reconstruction is the key technology to living donor liver transplantation, and the anatomical variations must be correctly treated.It can decrease the postoperative complications of blood vessel and bile ducts.
出处
《中国实用外科杂志》
CSCD
北大核心
2003年第2期96-98,共3页
Chinese Journal of Practical Surgery
关键词
活体肝移植
血管变异
外科处理
Living donor liver transplantation Vascular variations
