Organ Transplantation Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
Chin Med J (Engl). 2011 Oct;124(19):2986-9.
At present, revascularization is still one of the most critical technologies in orthotopic liver transplantation (OLT). Hepatic artery (HA) variations occur frequently in both donors and recipients. Moreover, there are always some pathological changes in the recipient hepatic artery. If handled improperly, it may cause complications after anastomosis. Therefore, arterial conduit could be used in primary OLT, re-OLT and multiple-OLT. This study aimed to investigate the indications, methods and techniques with usage of arterial conduit for HA revascularization during adult OLT.
We reviewed 1200 patients of consecutive OLTs performed during 2000 - 2009 in the First Affiliated Hospital of Sun Yat-sen University. Of these patients, 48 recipients with artery variations received HA revascularization with usage of arterial conduit and special postoperative managements. The indications, methods, techniques, and the managements of postoperative complications in adult OLT with usage of arterial conduit for HA revascularization were analyzed.
In 48 cases with artery bypass, the arterial conduit were anastomosed between donor hepatic artery and recipient infrarenal aorta (n = 32), between donor hepatic artery and recipient suprarenal aorta (n = 10), and between donor upper abdominal organ cluster artery and recipient suprarenal aorta (n = 6). The technique was applied in 4% (48/1200 cases) of the whole OLTs performed in the same period, and the patency rate of the conduits was 100%. Forty patients (83.3%) survived, and the average survival time was 3.9 years. Eight patients (16.7%) died (all due to tumor recurrence), while the average survival time was 1.2 years. All these patients have not experienced artery-related complications in their survival time.
When recipient HA has variations or pathological changes in OLT, the donor artery should be anastomosed to recipient abdominal aorta with an arterial conduit to achieve satisfactory outcomes. For arterial anastomosis can not be routinely performed, donor iliac artery as a conduit to be anastomosed with the recipient abdominal aorta is safe and effective.
目前，再血管化仍然是原位肝移植（OLT）中最关键的技术之一。供体和受者的肝动脉（HA）变异都很常见。此外，受者肝动脉常有一些病理变化。如果处理不当，可能会导致吻合后并发症。因此，动脉导管可用于OLT 、再 OLT 和多 OLT。本研究旨在探讨成人 OLT 中使用动脉导管进行 HA 再血管化的适应证、方法和技术。
回顾分析 2000 年至 2009 年在中山大学附属第一医院连续进行的 1200 例 OLT 患者。其中，48 例动脉变异患者接受了 HA 再血管化治疗，并使用了动脉导管和特殊的术后管理。分析了成人 OLT 中使用动脉导管进行 HA 再血管化的适应证、方法、技术和术后并发症的处理。
在 48 例动脉旁路手术中，将供肝动脉与受者肾下主动脉（n=32）、供肝动脉与受者肾上主动脉（n=10）、供肝上腹部器官簇动脉与受者肾上主动脉（n=6）吻合。该技术应用于同期进行的 1200 例 OLT 中的 4%（48/1200 例），导管通畅率为 100%。40 例（83.3%）患者存活，平均生存时间为 3.9 年。8 例（16.7%）患者死亡（均因肿瘤复发），平均生存时间为 1.2 年。所有这些患者在生存期间均未经历与动脉相关的并发症。
在 OLT 中，当受者 HA 存在变异或病理变化时，应通过动脉导管将供者动脉与受者腹主动脉吻合，以获得满意的效果。对于不能常规进行动脉吻合的情况，将供体髂动脉作为导管与受者腹主动脉吻合是安全有效的。
