Experiences of 120 microsurgical reconstructions of hepatic artery in living related liver transplantation
Experiences of 120 microsurgical reconstructions of hepatic artery in living related liver transplantation
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DOI：
10.1016/s0039-6060(96)80208-x
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发表时间：
1996-01-01
期刊：
影响因子：
3.8
通讯作者：
Yamaoka, Y
中科院分区：
文献类型：
--
作者：
Inomoto, T;Nishizawa, F;Yamaoka, Y
背景本文总结了120例活体肝移植中肝动脉的显微外科重建方法，并对其中存在的问题进行了讨论。从1991年1月至1994年7月，我们为105例终末期肝病儿童进行了活体亲属肝移植。在手术显微镜下，在室内连续放大约10倍的光场下进行动脉重建。26%的移植动脉直径小于2 mm：动脉重建所需的时间为49.5 +/-1.8分钟。在31例有两条移植动脉的病例中，有15例需要进行两次动脉重建。30例移植动脉与受体动脉的管径差，采用斜切小动脉17例，鱼嘴法10例，端侧吻合1例，漏斗法2例。在一个病例中，我们对受体肝动脉进行了内膜剥离，并替换了脾动脉。肝动脉血栓形成仅2例（1.7%）。显微外科技术克服了细小移植动脉形成肝动脉血栓的高风险，使不同口径的动脉得以重建，并以其精细的操作减少了动脉并发症。
Background. We reviewed 120 microsurgical reconstructions of a hepatic artery in living related liver transplantation and discussed the problems encountered.Methods. From January 1991 to July 1994 we performed a series of 105 living related liver transplantations on children with end-stage liver disease. Arterial reconstruction was performed under the optical field of a continuous room magnification of approximately 10 times with an operating microscope.Results. Twenty-six percent of the graft arteries were less than 2 mm in diameter: The time required for an arterial reconstruction was 49.5 +/- 1.8 minutes. In 15 of the 31 cases in which there were two graft arteries, two arterial reconstructions were required. The caliber difference between the graft artery and the recipient artery in 30 instances was dealt with by cutting an undersized artery obliquely (17 instances), by fish-mouth method (10 instances), by end-to-side anastomosis (I instance), or by funnelization method (2 instances). In one case we performed an intimal dissection of a recipient hepatic artery and substituted a splenic artery. consequently, hepatic arterial thrombosis occurred in only two cases (1.7%).Conclusions. Microsurgical technique has overcome the high risk of hepatic arterial thrombosis in cases of fine graft arteries, enabled the reconstruction of arteries with caliber difference, and decreased arterial complications with its delicate manipulation.