Steinbrück Klaus, Fernandes Reinaldo, Enne Marcelo, Vasconcelos Rafael, Bento Giuliano, Stoduto Gustavo, Auel Thomas, Pacheco-Moreira Lúcio Filgueiras
Hepatobiliary Surgery Unit, Serviço de Cirurgia Hepato-Biliar, Bonsucesso Federal Hospital-Health Ministry, Avenida Londres 616, Predio 3/2° Andar, 21041-030 Rio de Janeiro, RJ, Brazil.
Hepatobiliary Surgery Unit, Serviço de Cirurgia Hepato-Biliar, Bonsucesso Federal Hospital-Health Ministry, Avenida Londres 616, Predio 3/2° Andar, 21041-030 Rio de Janeiro, RJ, Brazil ; Transplantation Unit, São Francisco Hospital-Rio de Janeiro State Health Secretary, Rua Conde de Bonfim 1033, 20530-190 Rio de Janeiro, RJ, Brazil.
Case Reports Hepatol. 2014;2014:616251. doi: 10.1155/2014/616251. Epub 2014 Nov 16.
Background. An adequate blood flow is directly related to graft survival in living donor liver transplantation. However, in some cases, unfavorable conditions prevent the use of the hepatic artery for arterial reconstruction. Herein, we report a case in which the recipient right gastroepiploic artery was used as an option for arterial reconstruction in adult-to-adult living donor liver transplantation. Case Report. A 62-year-old woman, with cirrhosis due to hepatitis B associated with hepatocellular carcinoma, was submitted to living donor liver transplantation. During surgery, thrombosis of the hepatic artery with intimal dissection until the celiac trunk was observed, which precluded its use in arterial reconstruction. We decided to use the right gastroepiploic artery for arterial revascularization of the liver graft. Despite the discrepancy in size between donor hepatic artery and recipient right gastroepiploic artery, anastomosis was performed successfully. Conclusions. The use of the right gastroepiploic artery as an alternative for arterial revascularization of the liver graft in living donor liver transplantation should always be considered when the hepatic artery of the recipient cannot be used. For performing this type of procedure, familiarity with microsurgical techniques by the surgical team is necessary.
背景。充足的血流与活体供肝肝移植中移植物的存活直接相关。然而，在某些情况下，不利条件使得无法使用肝动脉进行动脉重建。在此，我们报告一例在成人对成人活体供肝肝移植中使用受者胃网膜右动脉作为动脉重建选择的病例。病例报告。一名62岁女性，因乙型肝炎相关性肝硬化合并肝细胞癌接受活体供肝肝移植。手术过程中，观察到肝动脉血栓形成并伴有内膜剥离直至腹腔干，这使得无法使用肝动脉进行动脉重建。我们决定使用胃网膜右动脉对肝移植进行动脉再血管化。尽管供体肝动脉与受者胃网膜右动脉在大小上存在差异，但吻合仍成功完成。结论。当受者肝动脉无法使用时，应始终考虑使用胃网膜右动脉作为活体供肝肝移植中肝移植动脉再血管化的替代方法。对于实施此类手术，手术团队熟悉显微外科技术是必要的。
