Shaked A A, Takiff H, Busuttil R W
Department of Surgery, University of California at Los Angeles.
Surg Gynecol Obstet. 1991 Sep;173(3):198-202.
Thrombosis of the hepatic artery during the early post hepatic transplant period results in massive hepatocyte necrosis, bile duct damage and subsequent graft loss. The incidence of this complication is increased when hepatic arterial reconstruction is possible only by the placement of an interposition infrarenal iliac artery graft. We describe 45 hepatic transplants with difficult arterial reconstruction in which the supraceliac aorta was used for arterial reconstruction. Indications for using the supraceliac aorta as the primary site for arterial reconstruction were inadequate inflow through a narrow recipient common hepatic artery in 51 per cent, previously thrombosed common hepatic artery in 27 per cent, mechanical obstruction of the celiac axis in 13 per cent or intimal dissection in 9 per cent. Direct anastomosis of the donor hepatic artery to the supraceliac aorta was achieved in 22 patients, reducing the need for a graft by 49 per cent. Short segments of iliac artery graft (17 patients) or aortic conduit (six patients) to the supraceliac aortas were required because of insufficient length of the donor artery. The incidence of arterial thrombosis and graft loss were zero per cent in adults and 12.5 per cent in children, both significantly less when compared with the 23.0 to 70.0 per cent thrombosis rate when graft is placed in an infrarenal position. We conclude that routine use of the supraceliac aorta for difficult hepatic arterial reconstruction decreases the need for arterial grafts, the incidence of hepatic arterial thrombosis and loss of hepatic grafts.
肝移植术后早期肝动脉血栓形成会导致大量肝细胞坏死、胆管损伤以及随后的移植物丢失。当仅通过置入一段肾下腹主动脉髂动脉移植物来进行肝动脉重建时，这种并发症的发生率会增加。我们描述了45例肝动脉重建困难的肝移植病例，这些病例中使用了腹腔干上主动脉进行动脉重建。将腹腔干上主动脉作为动脉重建的主要部位的指征包括：51%的患者因受体肝总动脉狭窄导致血流不足，27%的患者肝总动脉先前已形成血栓，13%的患者腹腔干机械性梗阻，9%的患者内膜剥离。22例患者实现了供体肝动脉与腹腔干上主动脉的直接吻合，使移植物的需求减少了49%。由于供体动脉长度不足，17例患者需要短段髂动脉移植物、6例患者需要主动脉管道连接到腹腔干上主动脉。成人动脉血栓形成和移植物丢失的发生率为0%，儿童为12.5%，与将移植物置于肾下位置时23.0%至70.0%的血栓形成率相比，两者均显著降低。我们得出结论，对于困难的肝动脉重建，常规使用腹腔干上主动脉可减少动脉移植物的需求、肝动脉血栓形成的发生率以及肝移植物的丢失。
