Egawa H, Asonuma K, Sakamoto Y, Iwasaki M, Kim I, Tanaka K
Department of Transplantation Surgery, Faculty of Medicine, Kyoto University, Kyoto, Japan.
Nihon Geka Gakkai Zasshi. 2001 Nov;102(11):798-804.
To decide how to reconstruct the portal vein and hepatic artery for liver transplantation, anatomical variation, diameter, length, and injury to vessels during surgery, and the quality of recipient vessels should be considered. Hence, it is of key importance for donor and recipient surgeries to prepare adequate vessels for reconstruction. For reconstruction of the portal vein, anastomosis with as large a diameter as possible is required to obtain good portal flow. In cases with sclerosing stenosis and old thrombus, technical innovations such as branch-patch, a conduit using a vein graft, and venoplasty using a venous patch are necessary. For reconstruction of the hepatic artery, selecting a satisfactory recipient artery, overcoming size mismatch, and gentle handling of a recipient artery with pathological changes are important. Arteries smaller than 3 mm are anastomosed with a surgical microscope using the united suture technique. The fishmouth technique or funnelization technique can be used for anastomoses with a significant size mismatch, and an autoarterial graft is used when arteries do not reach each other.
为了决定如何在肝移植中重建门静脉和肝动脉，应考虑解剖变异、直径、长度、手术期间血管的损伤以及受体血管的质量。因此，供体和受体手术准备足够的血管用于重建至关重要。对于门静脉重建，需要尽可能大直径的吻合以获得良好的门静脉血流。在存在硬化性狭窄和陈旧血栓的情况下，诸如分支补片、使用静脉移植物的导管以及使用静脉补片的静脉成形术等技术创新是必要的。对于肝动脉重建，选择满意的受体动脉、克服尺寸不匹配以及轻柔处理有病理改变的受体动脉很重要。小于3毫米的动脉使用联合缝合技术在手术显微镜下进行吻合。对于尺寸明显不匹配的吻合可使用鱼口技术或漏斗化技术，当动脉无法相互连接时使用自体动脉移植物。
