原位肝移植41例报告(1)
[摘要] 目的:探讨肝移植肝动脉重建方式与肝动脉栓塞或吻合口出血的预防与治疗。方法:回顾性分析2001 年12月～2007 年 11 月完成的 41例肝移植临床资料。供、受者动脉寻找到动脉主干与血管分叉处,剪开分叉处呈喇叭状,注意保护动脉内膜不受损伤。对供肝右肝动脉存在变异者作整形、重建4例,选择动脉内径较粗、内膜完整、口径相匹配的血管进行吻合。 结果:1 例肝移植术后第6天出现肝动脉吻合口出血,再次手术吻合口修补止血治愈;1例术后第8天肝动脉吻合口血栓形成,经DSA溶栓治疗后吻合口出血,再手术止血,最终死于肝衰竭及DIC;其余39例患者彩超证实未发生肝动脉栓塞或狭窄并存活。结论:肝动脉并发症的防治重点是吻合口的选择、变异血管的重建、操作精细、血管内膜完整、无张力吻合和适当地应用抗凝药物。
[关键词] 肝移植;肝动脉;吻合;并发症;防治
[中图分类号] R657.3 [文献标识码]B[文章编号]1673-7210(2010)06(b)-141-02
, 百拇医药
A report of 41 cases orthotopic liver transplantation
XU Zhidan, SHI Jun, WANG Yonggang, LUO Wenfeng, LI Xinchang, LUO Laibang, LONG Chengmei
(Department of Organ Transplantation, Jiangxi People's Hospital, Jiangxi Province, Nanchang 330006, China)
[Abstract] Objective: To investigate the methods of hepatic artery(HA) reconstruction, the prevention and treatment of hepatic artery thrombosis (HAT) and hemorrhage of artery stoma in orthotopic liver transplantation (OLT). Methods: A retrospective analysis was applied in 15 liver transplantations performed from December 2001 to October 2007. Graft and recipient's artery bole and crotch was found, then artery crotch was sheared openly and trimmed to the shape of trumpet. Artery endangium was protected carefully to be notinjured. 4 graft right hepatic artery variation was found and was performed reshaping and rebuilding. The artery with larger inner diameter, integrity endangium, matching of donor and recipient artery was choosed to be performed the anastomosis. Results: 1 patient appeared hemorrhoea of HA stoma in 6th day post-operation, reoperation was performed to restore the HA stoma, and the patient was cured. We applied selective hepatic arteriography and thrombodysis therapy for a patient of hepatie artericl thrombus the eight day after liver transplantation. The patient occurred hepatic artery hemorrhage and died because of liver fuction failuerand disseminated intrarascular coagulation after operation to hemostasis. The rest of patient was confirmed that they didn't occurrence HAT or HA stenosis by doppler ultrasound. Conclusion: Prevention and treatment's emphasis to complication of hepatic artery reconstruction includes the location of artery stoma, reconstruction of heterotopic hepatic artery, refined operation, integrity endangium, non-tension anastomosis, and adequate anticoagulant.
, 百拇医药
[Key words] Liver transplantation; Hepatic artery; Anastomosis; Complications; Prevention and treatment
血管重建是肝移植的关键技术,下腔静脉及门静脉管径较粗重建相对容易,而肝动脉变异较多及血管细,容易出现并发症;一旦出现并发症往往导致移植物失去功能,最终肝移植失败或需再次肝移植。肝移植肝动脉并发症的防治是肝移植成功与否的关键。肝动脉并发症包括肝动脉栓塞或狭窄以及吻合口出血。笔者对2001 年12月～2007 年 11 月在我院完成的 41 例肝移植患者并发症的防治进行探讨,分析总结肝动脉吻合方式及术后处理肝动脉并发症的体会,旨在积累肝动脉重建的经验,进一步提高肝移植手术成功率。
1 资料与方法
1.1 一般资料
本组患者41例,其中,男30 例,女11例;年龄 18～65岁,平均(45.0±7.5) 岁;原发病为肝豆状核变性1例,慢性纤维性肝硬化4例,乙型肝炎后肝硬化8例,慢性重型乙型病毒性肝炎 2 例,急性重型乙型病毒性肝炎 2 例,酒精性肝硬化2例,原发性肝癌 22例。所有病例供、受体均符合血型相符的原则,HLA配型良好。术前谷丙转氨酶(106.21±11.87) IU/L,谷草转氨酶(121.24±16.75) IU/L,总胆红素(32.18±8.76) μmol/L,直接胆红素(17.68±5.87) μmol/L,肝功能Chlid-Pugh分级:A级25例,B级10例,C级6例。, http://www.100md.com(徐志丹,时 军,王永刚,罗文峰,李新长,罗来邦,龙成美)
[关键词] 肝移植;肝动脉;吻合;并发症;防治
[中图分类号] R657.3 [文献标识码]B[文章编号]1673-7210(2010)06(b)-141-02
, 百拇医药
A report of 41 cases orthotopic liver transplantation
XU Zhidan, SHI Jun, WANG Yonggang, LUO Wenfeng, LI Xinchang, LUO Laibang, LONG Chengmei
(Department of Organ Transplantation, Jiangxi People's Hospital, Jiangxi Province, Nanchang 330006, China)
[Abstract] Objective: To investigate the methods of hepatic artery(HA) reconstruction, the prevention and treatment of hepatic artery thrombosis (HAT) and hemorrhage of artery stoma in orthotopic liver transplantation (OLT). Methods: A retrospective analysis was applied in 15 liver transplantations performed from December 2001 to October 2007. Graft and recipient's artery bole and crotch was found, then artery crotch was sheared openly and trimmed to the shape of trumpet. Artery endangium was protected carefully to be notinjured. 4 graft right hepatic artery variation was found and was performed reshaping and rebuilding. The artery with larger inner diameter, integrity endangium, matching of donor and recipient artery was choosed to be performed the anastomosis. Results: 1 patient appeared hemorrhoea of HA stoma in 6th day post-operation, reoperation was performed to restore the HA stoma, and the patient was cured. We applied selective hepatic arteriography and thrombodysis therapy for a patient of hepatie artericl thrombus the eight day after liver transplantation. The patient occurred hepatic artery hemorrhage and died because of liver fuction failuerand disseminated intrarascular coagulation after operation to hemostasis. The rest of patient was confirmed that they didn't occurrence HAT or HA stenosis by doppler ultrasound. Conclusion: Prevention and treatment's emphasis to complication of hepatic artery reconstruction includes the location of artery stoma, reconstruction of heterotopic hepatic artery, refined operation, integrity endangium, non-tension anastomosis, and adequate anticoagulant.
, 百拇医药
[Key words] Liver transplantation; Hepatic artery; Anastomosis; Complications; Prevention and treatment
血管重建是肝移植的关键技术,下腔静脉及门静脉管径较粗重建相对容易,而肝动脉变异较多及血管细,容易出现并发症;一旦出现并发症往往导致移植物失去功能,最终肝移植失败或需再次肝移植。肝移植肝动脉并发症的防治是肝移植成功与否的关键。肝动脉并发症包括肝动脉栓塞或狭窄以及吻合口出血。笔者对2001 年12月～2007 年 11 月在我院完成的 41 例肝移植患者并发症的防治进行探讨,分析总结肝动脉吻合方式及术后处理肝动脉并发症的体会,旨在积累肝动脉重建的经验,进一步提高肝移植手术成功率。
1 资料与方法
1.1 一般资料
本组患者41例,其中,男30 例,女11例;年龄 18～65岁,平均(45.0±7.5) 岁;原发病为肝豆状核变性1例,慢性纤维性肝硬化4例,乙型肝炎后肝硬化8例,慢性重型乙型病毒性肝炎 2 例,急性重型乙型病毒性肝炎 2 例,酒精性肝硬化2例,原发性肝癌 22例。所有病例供、受体均符合血型相符的原则,HLA配型良好。术前谷丙转氨酶(106.21±11.87) IU/L,谷草转氨酶(121.24±16.75) IU/L,总胆红素(32.18±8.76) μmol/L,直接胆红素(17.68±5.87) μmol/L,肝功能Chlid-Pugh分级:A级25例,B级10例,C级6例。, http://www.100md.com(徐志丹,时 军,王永刚,罗文峰,李新长,罗来邦,龙成美)