活体肝移植中肝动脉的显微外科重建：经验与教训。
Microsurgical reconstruction of hepatic artery in living donor liver transplantation: experiences and lessons.
机构信息
Division of Hepatobiliary and Pancreatic Surgery, Ministry of Public Health; and Key Laboratory of Organ Transplantation Zhejiang Province, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
出版信息
Hepatobiliary Pancreat Dis Int. 2009 Dec;8(6):575-80.
BACKGROUND
Hepatic artery (HA) reconstruction is one of the key steps for living donor liver transplantation (LDLT). The incidence of HA thrombosis has been reduced by the introduction of microsurgical techniques under a high resolution microscope or loupe.
METHODS
We report our experience in 101 cases of HA reconstruction in LDLTs using the graft-artery-unclamp and posterior-wall-first technique. The reconstructions were completed by either a plastic surgeon or a transplant surgeon.
RESULTS
The rate of HA thrombosis was 2% (2/101). The risk factors for failed procedures appeared to be reduced by participation of the transplant surgeon compared with the plastic surgeon. For a graft with duplicate arteries, we considered no branches should be discarded even with a positive clamping test.
CONCLUSIONS
HA reconstruction without clamping the graft artery is a feasible and simplified technique, which can be mastered by transplant surgeons with considerable microsurgical training.
背景
肝动脉（HA）重建是活体肝移植（LDLT）的关键步骤之一。通过在高分辨率显微镜或放大镜下使用显微外科技术，HA 血栓形成的发生率已经降低。
方法
我们报告了在 101 例 LDLT 中使用供体动脉夹闭和后壁优先技术进行 HA 重建的经验。重建由整形外科医生或移植外科医生完成。
结果
HA 血栓形成的发生率为 2%（2/101）。与整形外科医生相比，移植外科医生的参与似乎降低了手术失败的风险因素。对于具有双重动脉的移植物，我们认为即使夹闭试验阳性，也不应丢弃任何分支。
结论
不夹闭供体动脉的 HA 重建是一种可行且简化的技术，具有相当显微外科培训的移植外科医生可以掌握。
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