Microsurgical reconstruction of hepatic artery in living donor liver transplantation: experiences and lessons.
Microsurgical reconstruction of hepatic artery in living donor liver transplantation: experiences and lessons.
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发表时间：
2009-12
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通讯作者：
Sheng Yan;Qiyi Zhang;Yubing Yu;Jiang-Juan He;Wei-Lin Wang;Min Zhang;Yan Shen;Jian Wu;Xiao Xu;Shu-sen Zheng
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作者：
Sheng Yan;Qiyi Zhang;Yubing Yu;Jiang-Juan He;Wei-Lin Wang;Min Zhang;Yan Shen;Jian Wu;Xiao Xu;Shu-sen Zheng
背景肝动脉重建是活体肝移植的关键步骤之一。通过在高分辨率显微镜或放大镜下引入显微外科技术，HA血栓形成的发生率已经降低。方法：我们报告了101例应用移植动脉开放和后壁优先技术进行肝动脉重建的经验。重建由整形外科医生或移植外科医生完成。结果HA血栓形成率为2%（2/101）。与整形外科医生相比，移植外科医生的参与似乎降低了手术失败的风险因素。对于有重复动脉的移植物，我们认为即使夹闭试验阳性，也不应丢弃任何分支。结论：不夹闭移植动脉的HA重建是一种可行且简单的技术，经过大量显微外科培训的移植外科医生可以掌握。
BACKGROUND Hepatic artery (HA) reconstruction is one of the key steps for living donor liver transplantation (LDLT). The incidence of HA thrombosis has been reduced by the introduction of microsurgical techniques under a high resolution microscope or loupe. METHODS We report our experience in 101 cases of HA reconstruction in LDLTs using the graft-artery-unclamp and posterior-wall-first technique. The reconstructions were completed by either a plastic surgeon or a transplant surgeon. RESULTS The rate of HA thrombosis was 2% (2/101). The risk factors for failed procedures appeared to be reduced by participation of the transplant surgeon compared with the plastic surgeon. For a graft with duplicate arteries, we considered no branches should be discarded even with a positive clamping test. CONCLUSIONS HA reconstruction without clamping the graft artery is a feasible and simplified technique, which can be mastered by transplant surgeons with considerable microsurgical training.