Wakiya T, Sanada Y, Mizuta K, Urahashi T, Ihara Y, Yamada N, Okada N, Egami S, Nakata M, Hakamada K, Yasuda Y
Department of Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
Transplant Proc. 2013 Jan-Feb;45(1):323-9. doi: 10.1016/j.transproceed.2012.08.012.
There are currently 2 major therapeutic options for the treatment of hepatic artery complications: endovascular intervention and open surgery. We herein report a retrospective analysis of 14 pediatric patients with hepatic artery complications after pediatric living donor liver transplantation (LDLT) at our institution. We divided them into an open surgery group and an endovascular intervention group based on their primary treatment, and compared the results and outcomes. We then evaluated which procedure is more effective and less invasive. In the open surgery group, recurrent stenosis or spasm of the hepatic artery occurred in 3 of the 8 patients (37.5%). In the endovascular intervention group, 5 of the 6 patients were technically successfully treated by only endovascular treatment. Of the 5 successfully treated patients, 3 developed recurrent stenosis (60%). There were significant differences in the mean length of the operation for the first treatment of hepatic artery complications (open surgery, 428 minutes vs endovascular intervention, 160 minutes; P = .01) and in the mean value of the posttreatment aspartate aminotransferase (AST)/alanine aminotransferase (ALT) (open surgery > endovascular intervention; P = .04/.05). Although endovascular intervention needs to be examined in further studies to reduce the rate of relapse, it is a less invasive method for the patient and graft than open surgery.
血管内介入治疗和开放手术。我们在此报告了对我院14例小儿活体肝移植（LDLT）术后发生肝动脉并发症的儿科患者的回顾性分析。我们根据其主要治疗方法将他们分为开放手术组和血管内介入治疗组，并比较结果和预后。然后我们评估哪种手术更有效且侵入性更小。在开放手术组中，8例患者中有3例（37.5%）发生肝动脉反复狭窄或痉挛。在血管内介入治疗组中，6例患者中有5例仅通过血管内治疗在技术上获得成功治疗。在5例成功治疗的患者中，3例出现反复狭窄（60%）。肝动脉并发症首次治疗的平均手术时长（开放手术为428分钟，血管内介入治疗为160分钟；P = 0.01）以及治疗后谷草转氨酶（AST）/谷丙转氨酶（ALT）的平均值（开放手术组＞血管内介入治疗组；P = 0.04/0.05）存在显著差异。尽管血管内介入治疗需要在进一步研究中进行检验以降低复发率，但与开放手术相比，它对患者和移植物的侵入性更小。
