摘要
目的分析原位肝移植供肝动脉变异的处理方式和手术效果。方法回顾性分析2018年7月至2020年6月在清华大学附属北京清华长庚医院接受肝移植手术受者的临床病理资料。识别肝动脉变异情况和分布比例,记录变异供肝动脉的处理方式。需重建的变异肝动脉均在体外完成重建吻合。比较变异组和无变异组术后并发症情况及手术后6个月的随访情况。结果肝动脉变异率为16.4%(36/219),其中常见类型为变异的肝左动脉发自胃左动脉,变异的肝右动脉发自肠系膜上动脉。结扎及重建的变异的肝左动脉共20例,其中9例直接结扎,无需重建。结扎及重建的变异的肝右动脉共16例,其中13例与胃十二指肠动脉吻合重建。变异组与无变异组相比,移植术后动脉、胆道并发症发生率差异均无统计学意义(P>0.05)。结论体外重建可以很好地重构具有肝动脉变异的供肝动脉血流路径。供肝肝动脉变异不增加移植术后动脉、胆道并发症的发生风险。
Objective To explore the management and impact of donor hepatic artery variation during orthotopic liver transplantation.Methods Clinicopathological data were retrospectively reviewed for liver transplantation recipients from July 2018 to June 2020.Identification of hepatic artery variation type and management of donor hepatic artery variation were recorded.All reconstructions of hepatic artery variation were completed in vitro.Postoperative complications and 6-month follow-ups were compared between variant and control groups.Results The variation rate of hepatic artery was 16.4%(36/219).The common variant types were aberrant left hepatic artery derived from left gastric artery and aberrant right hepatic artery derived from superior mesenteric artery.A total of 20 variational left hepatic artery were ligated or reconstructed,of which 9 cases were ligated directly without reconstruction.A total of 16 variational right hepatic artery were ligated or reconstructed,of which 13 cases were anastomosed to gastroduodenal artery.Compared with control group,no statistic differences existed in arterial and biliary complications after transplantation in variant group(P>0.05).Conclusion In vitro reconstruction contributes to adequate blood flow path of donor hepatic artery with variation.Graft hepatic artery variation poses no elevated risk of arterial and biliary complications after liver transplantation.
作者
汤睿
李昂
侯昱丞
吴广东
童翾
周虎
徐光勋
宋继勇
于里涵
卢倩
Tang Rui;Li Ang;Hou Yucheng;Wu Guangdong;Tong Xuan;Zhou Hu;Xu Guangxun;Song Jiyong;Yu Lihan;Lu Qian(Hepatopancreatobiliary Center,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Institute for Precision Medicine,Tsinghua University,Beijing 102218,China)
出处
《腹部外科》
2021年第4期291-296,309,共7页
Journal of Abdominal Surgery
基金
国家科技重大专项(2017ZX100203205)
国家自然科学基金(81930119)
北京清华长庚医院研究基金(12019C1012)。
关键词
肝移植
动脉吻合
肝动脉变异
肝动脉栓塞
胆道并发症
Liver transplantation
Arterial anastomosis
Hepatic artery variation
Hepatic artery thrombosis
Biliary complications
