同种异体原位肝移植的复杂肝动脉重建经验总结

叶征辉; 赵红川; 耿小平; 黄帆; 王国斌; 余孝俊; 吴若林; 侯刘进

doi:10.3969/j.issn.1674-7445.2019.05.020

同种异体原位肝移植的复杂肝动脉重建经验总结

doi: 10.3969/j.issn.1674-7445.2019.05.020

230022 合肥，安徽医科大学第一附属医院普外科暨器官移植中心

基金项目:

国家自然科学基金 81702829

详细信息

作者简介:
叶征辉，男，1991年生，硕士，住院医师，研究方向为肝胆胰疾病，Email：767725431@qq.com

通讯作者:
赵红川，男，1969年生，博士，主任医师，研究方向为器官移植，Email：zhc0117@sina.com

中图分类号: R617, R619
计量
- 文章访问数: 143
- HTML全文浏览量: 19
- PDF下载量: 17
- 被引次数: 0
出版历程
- 收稿日期: 2019-07-16
- 网络出版日期: 2021-01-19
- 刊出日期: 2019-09-15

Experience summary of complex hepatic artery reconstruction in orthotopic liver transplantation

Department of General Surgery, Organ Transplantation Center, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China

More Information

Corresponding author: Zhao Hongchuan, Email: zhc0117@sina.com

摘要

摘要: 目的总结同种异体原位肝移植术中复杂肝动脉重建的相关经验。方法回顾性分析2015年1月至2019年3月期间行复杂肝动脉重建的7例肝移植受者资料。其中4例经典肝移植，3例背驮式肝移植。观察受者术中的一般情况，包括无肝期、术中出血量、肝动脉吻合时间、手术时间; 观察受者预后情况及并发症发生情况。结果 2例供者变异右肝动脉重建血管，分别用供者腹腔干或肝总动脉与受者肝总动脉吻合; 2例用髂动脉搭桥，然后供者肝动脉与受者腹主动脉吻合; 1例供者肠系膜上动脉与受者肝总动脉端端吻合; 1例供者腹腔干与受者脾动脉吻合; 仅1例因肝动脉吻合后出现急性肝动脉血栓，需再次行肝移植。6例肝移植受者均顺利完成手术，无围手术期死亡，无肝期49~77 min，术中出血量300~1 500 mL，肝动脉吻合时间23~56 min，手术时间5.3~11.1 h。术后住院时间23~56 d，均未出现肝动脉血栓、狭窄。所有受者术后2周内肝功能基本恢复正常，无严重外科并发症发生，移植肝均获得良好的功能。结论正确辨别肝动脉有否变异，选择适宜的方式处理供、受者肝动脉并重建新肝动脉血供，是肝移植术中的关键步骤。
- 肝移植 /
- 肝动脉 /
- 解剖变异 /
- 肝动脉重建 /
- 肝动脉搭桥 /
- 肝动脉血栓 /
- 外科并发症
Abstract: Objective To summarize the experience of complex hepatic artery reconstruction in orthotopic liver transplantation. Methods Clinical data of 7 liver transplantation recipients who underwent complex hepatic artery reconstruction from January 2015 to March 2019 were retrospectively analyzed. Among them, 4 recipients received classical liver transplantation and 3 cases underwent piggyback liver transplantation. Intraoperative general conditions including anhepatic phase, intraoperative blood loss, hepatic artery anastomosis time and operation time of the recipients were recorded. The clinical prognosis and complications were observed. Results In two donors, variant right hepatic artery was used for vascular reconstruction. The celiac trunk or the common hepatic artery of the donors was anastomosed with the common hepatic artery of the recipients. Iliac artery bypass was employed in 2 cases, and then the hepatic artery of the donors was anastomosed with the abdominal aorta of the recipients. The superior mesenteric artery of 1 donor was end-to-end anastomosed with the common hepatic artery of the recipient. The celiac trunk of 1 donor was anastomosed with the splenic artery of the recipient. Only 1 case was required to undergo secondary liver transplantation due to acute hepatic artery thrombosis after hepatic artery anastomosis. All the 6 recipients successfully completed the liver transplantation. No perioperative death was observed. The anhepatic phase endured from 49 to 77 min. The intraoperative blood loss was ranged from 300 to 1 500 mL. The anastomosis time of hepatic artery was 23-56 min. The operation time was ranged from 5.3 to 11.1 h. The length of postoperative hospital stay was 23-56 d. Neither hepatic artery thrombosis nor stenosis occurred. The liver function of all recipients was basically restored to normal within postoperative 2 weeks. No severe surgical complications occurred. The liver graft achieved excellent function. Conclusions Appropriate identification of the hepatic artery variation, proper management of liver artery of the donors and recipients and reconstructing the blood supply of liver graft are the crucial procedures of liver transplantation.
- Liver transplantation /
- Hepatic artery /
- Anatomical variation /
- Reconstruction of hepatic artery /
- Hepatic artery bypass /
- Hepatic artery thrombosis /
- Surgical complication

HTML全文

图 1 复杂肝动脉重建手术过程

A图示供者胃十二指肠动脉与变异右肝动脉吻合，吻合后血流良好; B图示供者脾动脉与变异右肝动脉吻合，吻合后血流良好; C图示供者髂动脉修整成一段长约22 cm血管段，完成动脉搭桥; D图示供者肠系膜上动脉与受者肝总动脉吻合; E图示供者腹腔干与受者脾动脉吻合; F图示肝动脉吻合后出现急性肝内型肝动脉血栓形成，再次行肝移植

Figure 1. The surgical procedure of complex hepatic artery reconstruction

下载: 全尺寸图片幻灯片

参考文献(24)

[1]	MIYAGI S, KAKIZAKI Y, SHIMIZU K, et al. Arterial and biliary complications after living donor liver transplantation: a single-center retrospective study and literature review[J]. Surg Today, 2018, 48(2):131-139. DOI: 10.1007/s00595-017-1515-9.
[2]	GANDINI R, KONDA D, TOTI L, et al. Endovascular mechanical thromboaspiration of right hepatic arterial thrombosis after liver transplantation[J]. Cardiovasc Intervent Radiol, 2017, 40(4):621-624. DOI: 10.1007/s00270-016-1538-4.
[3]	GARCÍA BERNARDO CM, ARGÜELLES GARCÍA B, REDONDO BUIL P, et al. Collateral development in thrombosis of the hepatic artery after transplantation[J]. Transplant Proc, 2016, 48(9):3006-3009. DOI: 10.1016/j.transproceed.2016.07.047.
[4]	CIROCCHI R, D'ANDREA V, LAURO A, et al. The absence of the common hepatic artery and its implications for surgical practice: results of a systematic review and Meta-analysis[J]. Surgeon, 2019, 17(3):172-185. DOI: 10.1016/j.surge.2019.03.001.
[5]	NÉMETH K, DESHPANDE R, MÁTHÉ Z, et al. Extrahepatic arteries of the human liver - anatomical variants and surgical relevancies[J]. Transpl Int, 2015, 28(10):1216-1226. DOI: 10.1111/tri.12630.
[6]	CHOI JM, KONG YG, KANG JW, et al. Coronary computed tomography angiography in combination with coronary artery calcium scoring for the preoperative cardiac evaluation of liver transplant recipients[J]. Biomed Res Int, 2017:4081525. DOI: 10.1155/2017/4081525.
[7]	PULITI REIGADA CH, DE ATAIDE EC, DE ALMEIDA PRADO MATTOSINHO T, et al. Hepatic artery thrombosis after liver transplantation: five-year experience at the state university of campinas[J]. Transplant Proc, 2017, 49(4):867-870. DOI: 10.1016/j.transproceed.2017.01.056.
[8]	DUFFY JP, HONG JC, FARMER DG, et al. Vascular complications of orthotopic liver transplantation: experience in more than 4 200 patients[J]. J Am Coll Surg, 2009, 208(5):896-905. DOI: 10.1016/j.jamcollsurg.2008.12.032.
[9]	IKEGAMI T, YOSHIZUMI T, UCHIYAMA H, et al. Hepatic artery reconstruction in living donor liver transplantation using surgical loupes: achieving low rate of hepatic arterial thrombosis in 741 consecutive recipients-tips and tricks to overcome the poor hepatic arterial flow[J]. Liver Transpl, 2017, 23(8):1081-1082. DOI: 10.1002/lt.24798.
[10]	叶征辉, 赵红川, 黄帆, 等.儿童小体积供肝肝移植治疗成人急性肝衰竭1例附文献复习[J].器官移植, 2018, 9(3):227-231.DOI: 10.3969/j.issn.1674-7445.2018.03.011. YE ZH, ZHAO HC, HUANG F, et al. Application of small-for-size graft of pediatric donor liver transplantation in an adult recipient with acute liver failure: a report of one case and literature review[J]. Organ Transplant, 2018, 9(3):227-231. DOI: 10.3969/j.issn.1674-7445.2018.03.011.
[11]	OTSUKA S, KANEOKA Y, MAEDA A, et al. Hepatic artery reconstruction with a continuous suture method for hepato-biliary-pancreatic surgery[J]. World J Surg, 2016, 40(4):951-957. DOI: 10.1007/s00268-015-3310-3.
[12]	JWA EK, KIM JD, CHOI DL. Comparison of hepatic artery reconstruction using surgical loupe and operating microscope during living donor liver transplantation focusing on the beginner's point[J]. Ann Hepatobiliary Pancreat Surg, 2019, 23(2):122-127. DOI: 10.14701/ahbps.2019.23.2.122.
[13]	KAZEMI K, SAMIDOOST P, DEILAMI HN, et al. A new consideration in hepatic artery reconstruction in adult liver transplant: arterial transposition versus extra-anatomic jump grafts[J]. Exp Clin Transplant, 2017, 15(Suppl 1):204-207.
[14]	PISKIN T, DEMIRBAS T, YALCIN L, et al. Recipient splenic artery utilization for arterial re-anastomosis in living donor liver transplantation: single-center experience[J]. Hepatogastroenterology, 2012, 59(116):1263-1264. DOI: 10.5754/hge11642.
[15]	PIARDI T, LHUAIRE M, BRUNO O, et al. Vascular complications following liver transplantation: a literature review of advances in 2015[J]. World J Hepatol, 2016, 8(1):36-57. DOI: 10.4254/wjh.v8.i1.36.
[16]	MA N, SONG Z, DONG C, et al. Risk factors of hepatic artery thrombosis in pediatric deceased donor liver transplantation[J]. Pediatr Surg Int, 2019, 35(8):853-859. DOI: 10.1007/s00383-019-04500-6.
[17]	KUTLUTURK K, SAHIN TT, KARAKAS S, et al. Early hepatic artery thrombosis after pediatric living donor liver transplantation[J]. Transplant Proc, 2019, 51(4):1162-1168. DOI: 10.1016/j.transproceed.2019.01.104.
[18]	LEE M, AGOSTINI-VULAJ D, GONZALEZ RS. Evaluation of histologic changes in the livers of patients with early and late hepatic artery thrombosis[J]. Hum Pathol, 2019, 90: 8-13. DOI: 10.1016/j.humpath. 2019.04.019.
[19]	CHOI HJ, KIM DG, KIM Y, et al. Clinical course of hepatic artery thrombosis after living donor liver transplantation using the right lobe[J]. Liver Transpl, 2018, 24(11):1554-1560. DOI: 10.1002/lt.25065.
[20]	王伟, 叶啟发, 胡晓燕, 等.肝移植术后肝动脉栓塞的诊治进展[J].中华肝胆外科杂志, 2018, 24(3):211-213. DOI: 10.3760/cma.j.issn.1007-8118.2018.03.018. WANG W, YE QF, HU XY, et al. Progress in the diagnosis and treatment of hepatic artery thrombosis after liver transplantation[J]. Chin J Hepatobil Surg, 2018, 24(3):211-213. DOI:10.3760/cma.j.issn. 1007-8118.2018.03. 018.
[21]	ASTARCIOGLU I, EGELI T, GULCU A, et al. Vascular complications after liver transplantation[J]. Exp Clin Transplant, 2019, DOI:10.6002/ect.2018.0240[Epubahead of print].
[22]	ZOU SJ, CHEN D, LI YZ, et al. Monitoring hepatocyte dysfunction and biliary complication after liver transplantation using quantitative hepatobiliary scintigraphy[J]. Medicine (Baltimore), 2015, 94(45):e2009. DOI: 10.1097/MD.0000000000002009.
[23]	ZHANG L, TIAN M, XUE F, et al. Diagnosis, incidence, predictors and management of postreperfusion syndrome in pediatric deceased donor liver transplantation: a single-center study[J]. Ann Transplant, 2018, 23:334-344. DOI: 10.12659/AOT.909050.
[24]	BEZINOVER D, DIRKMANN D, FINDLAY J, et al. Perioperative coagulation management in liver transplant recipients[J]. Transplantation, 2018, 102(4):578-592. DOI: 10.1097/TP.0000000000002092.