Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
Updates Surg. 2012 Sep;64(3):173-7. doi: 10.1007/s13304-012-0164-1. Epub 2012 Jul 7.
Sequential portal and arterial revascularization (SPAr) is the most common method of graft reperfusion at liver transplantation (LT), contemporaneous portal and arterial revascularization (CPAr) was used to reduce arterial ischemia to the bile ducts. Aim of this pilot study is to prospectively compare SPAr (group 1 #38) versus CPAr (group 2 #42) in 80 consecutive LTs. Biliary anastomosis was always duct to duct [T-tube in 21 % of cases (p = 0.83) in both groups]. CPAr had longer warm ischemia 61 ± 10 versus 39 ± 13 min, p < 0.0001, while SPAr had longer arterial ischemia 96 ± 39 min (p = 0.0001). No PNF while DGF was encountered in 10 versus 5 % (p = 0.32). One-year graft and patient's survival were respectively 87 versus 93 % and 83 versus 88 % in groups 1 and 2 (p = 0.31 and p = 0.39). At a median follow-up of 19 ± 8 versus 17 ± 8 months (p = 0.24), biliary complications were 28 %, being 39 % in group 1 and 19 % in group 2 (p = 0.04). Anastomotic stenoses were present in 11 versus 12 % (p = 0.84), biliary leakage in 5 versus 5 % (p = 0.72) and intrahepatic non-anastomotic biliary strictures in 23 versus 0 % (p = 0.0008) in groups 1 and 2. CPAr is safe and feasible and reduces the incidence of intrahepatic biliary strictures by decreasing the duration of arterial ischemia to the intrahepatic bile ducts.
序贯门静脉和动脉再灌注（SPAr）是肝移植（LT）中最常见的移植物再灌注方法，同期门静脉和动脉再灌注（CPAr）用于减少胆管的动脉缺血。本前瞻性研究的目的是比较 80 例连续 LT 中 SPAr（组 1 #38）与 CPAr（组 2 #42）的效果。胆管吻合术始终为胆管对胆管[两组中 T 管的比例分别为 21%（p = 0.83）]。CPAr 的热缺血时间更长，为 61 ± 10 分钟，而 SPAr 为 96 ± 39 分钟（p < 0.0001）。SPAr 的动脉缺血时间更长，为 96 ± 39 分钟（p = 0.0001）。无 PNF 而 DGF 在 10 例和 5 例中发生（p = 0.32）。组 1 和组 2 的 1 年移植物和患者存活率分别为 87%和 93%，83%和 88%（p = 0.31 和 p = 0.39）。在中位随访 19 ± 8 个月和 17 ± 8 个月（p = 0.24）时，胆管并发症分别为 28%，组 1 为 39%，组 2 为 19%（p = 0.04）。吻合口狭窄分别为 11%和 12%（p = 0.84），胆漏分别为 5%和 5%（p = 0.72），肝内非吻合性胆管狭窄分别为 23%和 0%（p = 0.0008）。CPAr 是安全可行的，通过减少肝内胆管的动脉缺血时间，降低了肝内胆管狭窄的发生率。
