Department of Surgery, Division of Hepatobiliary Surgery and Transplantation, New York Medical College, New York, New York 10595, USA.
Hepatobiliary Pancreat Dis Int. 2010 Jun;9(3):319-20.
Vascular anatomy of the liver is varied, and the "standard" anatomy is seen in 55%-80% of cases. It is very important that extrahepatic arteries are identified precisely at the time of graft procurement to avoid injuries that might compromise the liver function. In the present case the liver donor had the vascular anatomy of Michels type VII, e.g. a hepatic artery originating from the celiac trunk and going to the left lobe, an accessory left hepatic artery coming from the left gastric artery, and a replaced right hepatic artery coming from the superior mesenteric artery. This pattern of vascular supply is uncommon, representing less than 5% of cases. The replaced hepatic artery was reconstructed in the back-table with polypropylene suture 7.0 by connecting it to the stump of the splenic artery, and the celiac trunk of the graft was anastomosed to the recipient common hepatic artery.
肝脏的血管解剖结构多种多样，“标准”解剖结构可见于 55%-80%的病例中。在获取供肝时，准确识别肝外动脉非常重要，以避免可能损害肝功能的损伤。在本例中，供肝者的血管解剖结构属于 Michels 型 VII 型，即肝固有动脉发自腹腔干并走向左叶，副左肝动脉发自胃左动脉，替代右肝动脉发自肠系膜上动脉。这种血管供应模式并不常见，不到 5%的病例会出现这种情况。替代肝动脉通过将其与脾动脉残端连接，用 7.0 号聚丙烯缝线在体外重建，供肝的腹腔干与受体的肝总动脉吻合。
