Arterial reconstruction in hepatic artery occlusions in adult living donor liver transplantation, using gastric vessels
Arterial reconstruction in hepatic artery occlusions in adult living donor liver transplantation, using gastric vessels
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DOI：
10.1016/j.surg.2007.11.018
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发表时间：
2008-05-01
期刊：
影响因子：
3.8
通讯作者：
Chiang, Yuan-Cheng
中科院分区：
文献类型：
--
作者：
Wang, Chib-Chi;Lin, Tsan-Shiun;Chiang, Yuan-Cheng
背景当不能使用天然HA或发生HA并发症时，需要在肝移植中替代肝动脉（HA）。我们描述了在成人间活体肝移植（LDLT）中使用胃网膜右动脉（RGEA）和胃左动脉（LGA）作为替代HA流入的适应证、技术和结果。从1999年1月至2006年6月，130例患者接受了初次成人间LDLT（不包括双移植物、移植）。7例患者因肝动脉并发症需要HA替代治疗。分析受者和移植血管的人口统计学特征、动脉并发症和使用的备用动脉。126例患者接受了右叶肝移植，4例接受了左叶肝移植。4例患者由于初次移植期间发现受体HA的内膜夹层而需要HA替代品，3例患者在HA血栓形成的再次手术期间接受了挽救治疗。RGEA用于5例患者，LGA用于2例患者。4例患者在长期随访中没有进一步的并发症。1例患者发生胆管狭窄需要干预，2例患者发生胆漏。1例胆漏患者的胆漏自行消退，无后遗症。1例患者因HA闭塞再次手术后胆漏和脓毒症导致移植物丢失。RGEA和LGA可成功用作肝动脉血运重建的替代HA流入，在LDLT中具有良好的结果。与间置移植物相比，该方法具有单吻合的优势。
Background. Alternatives to the hepatic artery (HA) are needed in liver transplantation when the native HA cannot be used or when HA complications develop. We describe the indications, technique, and results Of our experience using the right gastroepiploic (RGEA) and left gastric (LGA) arteries as alternative HA inflow in adult-to-adult living donor liver transplantation (LDLT).Methods. From January 1999 to June 2006, 130 patients underwent Primary adult-to-adult LDLT (excluding dual graft, transplantations). Seven patients required an HA alternative due to hepatic arterial complication. The recipient and graft demographic characteristics, arterial complication, and alternate arteries used were analyzed.Results. One hundred twenty-six (126) patients received right lobe liver grafts and four received left lobe grafts. Four patients required an HA alternative due to intimal dissection of the recipient HA found during primary transplant, and three patients had salvage during re-operation for HA thrombosis. The RGEA was used in five patients and LGA in two patients. Four patients had no further complication on long-term follow-up. One patient had biliary stricture requiring intervention, and two patients had bile leak. One bile leak recipient had his bile leakage resolved spontaneously without sequelae. One patient with two graft HA reconstructed had graft loss due to bile leak and sepsis following re-operation for HA occlusion.Conclusion. The RGEA and LGA can be successfully used as alternative HA inflow for hepatic arterial revascularization with good results in LDLT The method has the advantage of single anastomosis compared to an interposition graft.