Anatomic variation of the right hepatic artery and its reconstruction for living donor liver transplantation using right lobe graft
Anatomic variation of the right hepatic artery and its reconstruction for living donor liver transplantation using right lobe graft
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DOI：
10.1016/j.transproceed.2005.01.068
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发表时间：
2005-03-01
影响因子：
0.9
通讯作者：
Kim, KK
中科院分区：
文献类型：
--
作者：
Ahn, CS;Lee, SG;Kim, KK
对2002年96例成人至成人活体供肝右肝移植的右肝动脉(RHA)的解剖和重建进行了分析。大多数右肝为单肝口(n=185，96%)。7例(4%)右肝显示多支动脉，其中5例为替代动脉，2例为副动脉。3例移植肝有两个独立的开口：1例重建双侧动脉残端，2例因背部出血较多而结扎副动脉。移植物RHA直径1~4 mm，平均2.4 mm。超过60%(59/96)的移植动脉与受体RHA的远端分支吻合以达到大小匹配。移植动脉与RHA以外的血管吻合11条，其中左肝动脉8条，胃网膜右动脉3条，大小匹配5条，RHA既往损伤6条。5个病例显示出严重的大小错配，超过两倍。中位随访时间为270天。在1例患者中，术后第3天出现壁内血栓，需要翻修吻合口。另一位患者在术后第16天发生动脉狭窄，此时侧支动脉已经形成。与动脉重建相关的总并发症发生率为2%。总之，只要掌握准确的解剖学知识，选择合适的受体动脉残端，再加上经验丰富的技术，右叶移植可能会取得理想的效果。
We analyzed the anatomy and reconstruction of the right hepatic artery (RHA) in 96 cases of adult-to-adult living donor right liver transplantations, during 2002. Most right livers had a single orifice (n = 185, 96%). Seven right livers (4%) showed multiple arteries, namely a replaced artery in five cases and accessory arteries in two cases. Three liver grafts had two separate orifices: both arterial stumps were reconstructed in one case, and accessory arteries were ligated in two cases because of sufficient back bleeding. The mean diameter of the graft RHA was 2.4 mm (1-4). More than 60% (59 of 96) of graft arteries were anastomosed with distal branches of recipient RHA for size matching. Eleven graft arteries were anastomosed to vessels other than the RHA, namely the left hepatic artery [LHA] in eight right gastroepiploic artery in three: for size matching in five and due to previous injury of RHA in six. Five cases showed significant size-mismatches of more than twofold. The median follow-up period was 270 days. In one patient, an intramural thrombus developed on postoperative day 3 requiring a revision of the anastomosis. In another patient, arterial stenosis occurred on postoperative day 16 a time when collateral arteries had developed. The overall complication rate related to arterial reconstruction was 2%. In conclusion, with precise knowledge of the anatomy, an adequate selection of recipient arterial stump, and an experienced technique, a desirable result may be achieved in right lobe transplantation.