小儿活体肝移植中肝动脉的微血管吻合：由一位外科医生完成的 73 例连续病例。
Microvascular Hepatic Artery Anastomosis in Pediatric Living Donor Liver Transplantation: 73 Consecutive Cases Performed by a Single Surgeon.
机构信息
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto; the Divisions of Plastic and Reconstructive Surgery and Pediatric Surgery, The Hospital for Sick Children; and the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California Keck School of Medicine.
出版信息
Plast Reconstr Surg. 2018 Dec;142(6):1609-1619. doi: 10.1097/PRS.0000000000005044.
BACKGROUND
Living donor liver transplantation is an important strategy of procuring segmental liver allografts for pediatric patients with liver failure, as suitably sized whole donor organs are scarce. The early pediatric living donor liver transplantation experience was associated with high rates of hepatic artery thrombosis, graft loss, and mortality. Collaboration with microsurgeons for hepatic artery anastomosis in pediatric living donor liver transplantation has decreased rates of arterial complications; however, reported outcomes are limited.
METHODS
A 14-year retrospective review was undertaken of children at the authors' institution who underwent living donor liver transplantation with hepatic artery anastomosis performed by a single microsurgeon using an operating microscope. Data were collected on demographics, cause of liver failure, graft donor, vessel caliber, vessel anastomosis, arterial complications, and long-term follow-up.
RESULTS
Seventy-three children with end-stage liver failure underwent living donor liver transplantation with microvascular hepatic artery anastomosis. The commonest cause for liver failure was biliary atresia (63 percent). A total of 83 end-to-end hepatic artery anastomoses were completed using an operating microscope. Hepatic artery complications occurred in five patients, consisting of three cases of kinked anastomoses that were revised without complications and two cases of hepatic artery thrombosis (3 percent), of which one resulted in graft loss and patient death. Patient survival was 94 percent at 1 year and 90 percent at 5 years.
CONCLUSIONS
Microvascular hepatic artery anastomosis in pediatric patients undergoing living donor liver transplantation is associated with a low hepatic artery complication rate and excellent long-term liver graft function. Collaboration between microsurgeons and transplant surgeons can significantly reduce technical complications and improve patient outcomes.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
背景
活体肝移植是获取肝功能衰竭的儿科患者所需的节段性肝移植物的重要策略，因为合适大小的整个供体器官稀缺。早期儿科活体肝移植的经验与肝动脉血栓形成、移植物丢失和死亡率高有关。与微外科医生合作进行肝动脉吻合术，可降低肝动脉并发症的发生率;然而，报告的结果是有限的。
方法
作者对所在机构接受同种异体肝移植的儿童进行了 14 年的回顾性研究，这些儿童的肝动脉吻合术由一位微外科医生在手术显微镜下进行。收集的数据包括人口统计学资料、肝功能衰竭的原因、供体器官、血管口径、血管吻合、动脉并发症和长期随访。
结果
73 例终末期肝功能衰竭儿童接受了同种异体肝移植，微血管肝动脉吻合术。肝功能衰竭的最常见原因是胆道闭锁（63%）。共完成 83 例端端肝动脉吻合术，均在手术显微镜下进行。5 例患者发生肝动脉并发症，包括 3 例吻合口扭曲，无需并发症即可修复，2 例肝动脉血栓形成（3%），其中 1 例导致移植物丢失和患者死亡。1 年和 5 年时患者生存率分别为 94%和 90%。
结论
小儿活体肝移植中微血管肝动脉吻合术与低肝动脉并发症发生率和良好的长期肝移植物功能相关。微外科医生和移植外科医生之间的合作可以显著降低技术并发症，改善患者结局。
临床问题/证据水平：治疗性，IV。
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