Department of Hepatobiliary Surgery, Chinese PLA Postgraduate Medical School, Chinese PLA General Hospital, Beijing, China.
Cell Biochem Biophys. 2013 Mar;65(2):257-62. doi: 10.1007/s12013-012-9421-7.
There is an emergent need for improving the microsurgical technique of variant arterial anastomosis to reduce the often seen surgery-related complications. We describe in this article our experience in improving this technique, in 73 living donor liver grafts (64 right lobes, 9 left lobes) in patients with end-stage liver disease during living donor liver transplantation. The hepatic arteries were evaluated preoperatively with computed tomography and magnetic resonance angiography. In this series, 13 grafts (17.80 %) with variant hepatic artery were conducted arterioplasty on a back-table under a loupe or a high-power microscope, which included one recipient in situ interposition vessel graft of recipient proper hepatic artery for artery reconstruction. The back-table reconstruction time was 16 ± 5.6 min. No arterial thrombosis was found in these cases during the 6-month postoperative follow-up. On the basis of our experience, we suggest that back-table microsurgical plasty for graft with arterial variation should be applied to minimize operative difficulties and to avoid arterial complications in living donor liver transplantation.
在活体肝移植中，为了降低常见的手术相关并发症，迫切需要提高变异动脉吻合的显微外科技术。我们在这篇文章中描述了我们在 73 例终末期肝病患者的 64 例右叶和 9 例左叶活体供肝中改进这一技术的经验。术前通过 CT 和磁共振血管造影评估肝动脉。在本系列中，对 13 例（17.80%）变异肝动脉供肝在手术台上使用显微镜或放大镜进行动脉成形术，其中包括 1 例受体原位右肝固有动脉间置血管移植进行动脉重建。手术台上重建时间为 16±5.6 分钟。在术后 6 个月的随访中，这些病例均未发现动脉血栓形成。基于我们的经验，我们建议对存在动脉变异的供肝进行手术台上显微外科成形术，以最小化手术难度并避免活体肝移植中的动脉并发症。
