肝移植术中异体髂动脉架桥重建肝动脉的临床效果观察

摘要

目的 了解肝移植术中特殊情况下异体髂动脉架桥重建肝动脉的临床效果.方法 回顾2004年至2010年首都医科大学附属北京佑安医院肝移植中心进行的427例肝移植临床资料,分析异体髂动脉架桥重建肝动脉的情况.结果 427例患者中,有12例患者共进行了13次成功的异体髂动脉架桥重建肝动脉,其中与腹主动脉架桥11例次,与脾动脉架桥1例次,与左侧髂总动脉架桥1例次；因二次肝移植而行架桥者4例次,因受体肝动脉不能利用而动脉架桥9例次(其中l例为活体右半肝移植)；架桥耗时90 ～ 120 min;移植物平均存活时间为(511.8 ±573.9)d(2～1 577 d,中位时间270 d),受体平均存活时间为(554.5±606.1)d(2～1 577 d,中位时间317 d)；随访期间无肝动脉相关合并症发生.结论 异体髂动脉架桥对于各种原因所致的肝动脉异常而不能按常规方法吻合的受体,是一种安全有效的肝动脉重建方式.但术前病情或合并症常可能影响这部分患者的术后生存.%Objective To learn the clinical outcomes of hepatic artery bypass reconstruction of liver transplantation (LT) using allogenic iliac artery on special occasions. Methods The clinical data of 427 patients who received LT from 2004 to 2010 in our liver transplantation center were reviewed retrospectively and the methods and clinical outcomes of hepatic artery bypass reconstruction of LT using allogenic iliac artery were analyzed. Results Hepatic artery bypass reconstruction were successfully performed 13 times in 12 cases by using allogenic iliac artery; 11 times were allogenic iliac artery-recipient's abdominal aorta bypass, 1 time was allogenic iliac artery-recipient's splenetic artery bypass, 1 time was allogenic iliac artery-recipient's left common iliac artery bypass; 4 times of hepatic artery bypass reconstruction were performed because of the second LT, 9 times of the reconstruction were performed because of useless of recipients' hepatic artery (including one living donor LT, LDLT). Time consumption of hepatic artery bypass construction was ranged from 90 to 120 minutes. The grafts survival time was (511.8 ± 573. 9 ) days ( range from 2 to 1 577 days, median 270 days) , the recipients survival time was (554.5 ±606. 1 ) days (range from 2 to 1 577days, median time 317 days). There were no complications related to hepatic artery bypass reconstruction in the follow-up period. Conclusion Hepatic artery bypass reconstruction of LT using allogenic iliac artery on special occasions is a safe and effective method, but the preexisting comorbidities and poor situations of recipient may lead to poor survival after LT.