Right Gastroepiploic Artery Is the First Alternative Inflow Source for Hepatic Arterial Reconstruction in Living Donor Liver Transplantation
Right Gastroepiploic Artery Is the First Alternative Inflow Source for Hepatic Arterial Reconstruction in Living Donor Liver Transplantation
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DOI：
10.1016/j.transproceed.2012.01.057
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发表时间：
2012-03-01
影响因子：
0.9
通讯作者：
Lee, S. -G.
中科院分区：
文献类型：
--
作者：
Ahn, C. -S.;Hwang, S.;Lee, S. -G.
背景。活体供肝移植（LDLT）术后动脉血流充足与移植物存活及术后并发症的预防密切相关。然而，受术者的一些不利的肝动脉状况阻碍了重建，需要替代残肢。我们采用右胃网膜动脉（RGEA）作为肝血流的第一选择。从2006年1月至2008年12月，我们在肝动脉吻合术中进行了754例ldlt，其中RGEA 28例。动脉吻合由一名外科医生在859显微镜下使用端到端间断缝合技术进行。RGEA在距胃大弯和大网膜15cm处被动员。RGEA应用的适应症包括：既往经动脉化疗栓塞造成的严重肝动脉损伤（n = 14），双瓣LDLT移植需要额外的动脉血流（n = 13），受体肝动脉血流不足（n = 3），肝门剥离期间动脉损伤（n = 3）。离体RGEA平均直径2.0 +/- 0.2 mm（范围1.0-2.5）。大多数肝动脉吻合术的尺寸差异大于两倍。所有重建肝动脉血流显示良好；随访56个月，无并发症发生。使用RGEA作为替代动脉流入是一种简单、可靠的方法，适用于受体肝动脉或多支移植动脉不足的情况。
Background. Sufficient arterial flow after living donor liver transplantation (LDLT) is closely related to graft survival and prevention of postoperative complications. However, some unfavorable hepatic arterial conditions in recipients preclude reconstruction, requiring alternative stumps. We have used the right gastroepiploic artery (RGEA) as a first alternative for hepatic inflow.Methods. From January 2006 to December 2008, we performed 754 LDLTs including 28 cases of RGEA among hepatic arterial anastomoses. The arterial anastomosis was performed by an single surgeon under 859 a microscope using an end-to-end interrupted suture technique. RGEA was mobilized over 15 cm from the greater curvature of stomach and greater omentum.Results. The indications for RGEA use included severe hepatic arterial injury from previous transarterial chemoembolization (n = 14), need for additional arterial flow in dual-grafts LDLT (n = 13), poor blood flow from the recipient hepatic artery (n = 3), and arterial injury during hilar dissection (n = 3). The mean diameter of the isolated RGEA was 2.0 +/- 0.2 mm (range: 1.0-2.5). Most hepatic arterial anastomoses were performed with a significant size discrepancy of more than twofold. All reconstructed hepatic arterial flowes showed good; no complication was identified during the mean follow-up period of 56 months to date.Conclusions. Using RGEA as an alternative arterial inflow is a simple, reliable procedure for situations of inadequate recipient hepatic or multiple graft arteries.