Mori K, Nagata I, Yamagata S, Sasaki H, Nishizawa F, Takada Y, Moriyasu F, Tanaka K, Yamaoka Y, Kumada K
Second Department of Surgery, Faculty of Medicine, Kyoto University, Japan.
Transplantation. 1992 Aug;54(2):263-8. doi: 10.1097/00007890-199208000-00014.
Microvascular surgery for the reconstruction of the graft artery has been used since the 8th case in our series of 14 liver transplantations using living-related donors, and the clinical results have been compared between the first seven cases (the Loupe group) and the last seven cases (the Micro group). Seven arteries in 7 grafts were reconstructed with the use of loupe magnification in the Loupe group, while 8 arteries in 7 grafts were anastomosed with microscopic techniques in the Micro group. Statistically, there was no difference between the two groups in general background, including age, body weight and primary disease of the recipient, and in medical and surgical factors possibly relating to postoperative thrombosis of the hepatic artery. In two cases in the Loupe group, one or two additional reconstructions were necessary to obtain sufficient blood flow, while 8 arteries were anastomosed in the Micro group without any arterial complication in the postoperative period. There was no difference in time required for completing the arterial reconstruction (45.1 +/- 18.1 min in the Loupe versus 44.4 +/- 6.9 min in the Micro [mean +/- SEM]). Postoperative ultrasonic Doppler duplex study demonstrated a temporary decrease in the arterial flow in 2 cases of the Loupe group, and partial thrombosis of the artery was suspected. Additionally there were two episodes of hepatic artery thrombosis in 1 case of the Loupe group, in which emergent revision for thrombectomy and reanastomosis was performed at the first episode. This illustrated the higher incidence of arterial complications in the Loupe group compared with the Micro group (4 episodes/7 arteries in the Loupe versus 0/8 arteries in the Micro, P less than 0.05). In the present series there were no graft failures or arterial complications in the three deaths in the series. The clinical improvements achieved by microvascular surgery in living-donor liver transplantation suggest an alternative technical strategy for dealing with problematic arterial reconstruction in adult liver transplantation.
在我们使用亲属活体供肝的14例肝移植系列手术中，自第8例起采用微血管手术重建移植肝动脉，并对前7例（放大镜组）和后7例（显微镜组）的临床结果进行了比较。放大镜组7例移植肝中的7条动脉采用放大镜放大进行重建，而显微镜组7例移植肝中的8条动脉采用显微技术进行吻合。统计学上，两组在一般背景方面无差异，包括受者的年龄、体重和原发疾病，以及可能与肝动脉术后血栓形成相关的医学和手术因素。放大镜组有2例需要进行一次或两次额外重建以获得足够血流，而显微镜组8条动脉吻合后术后无任何动脉并发症。完成动脉重建所需时间无差异（放大镜组为45.1±18.1分钟，显微镜组为44.4±6.9分钟[均值±标准误]）。术后超声多普勒双功检查显示放大镜组2例动脉血流暂时减少，怀疑动脉部分血栓形成。此外，放大镜组1例发生2次肝动脉血栓形成，首次发作时进行了紧急血栓清除和重新吻合术。这表明放大镜组动脉并发症的发生率高于显微镜组（放大镜组4次/7条动脉 versus 显微镜组0次/8条动脉，P<0.05）。在本系列中，该系列3例死亡病例均无移植肝失功或动脉并发症。微血管手术在活体供肝肝移植中取得的临床改善提示了一种处理成人肝移植中有问题的动脉重建的替代技术策略。
