Jurim O, Shaked A, Kiai K, Millis J M, Colquhoun S D, Busuttil R W
Department of Surgery, UCLA School of Medicine.
Ann Surg. 1993 Jul;218(1):10-2. doi: 10.1097/00000658-199307000-00003.
The authors assessed the prevalence and clinical significance of the celiac compression syndrome in liver transplantation patients.
Compression of the celiac axis by the median arcuate ligament of the diaphragm, causes a decrease in celiac artery blood flow which may lead to hepatic artery thrombosis in patients undergoing orthotopic liver transplantation.
From July 1991 to July 1992, 17 (10%) cases of celiac compression syndrome were identified among 164 consecutive adult patients who underwent liver transplantation. The diagnosis was confirmed by blood flow recording demonstrating a typical pattern of accentuated decrease in celiac blood flow during expiration.
Surgical transection of the median arcuate ligament resulted in normalization of the hepatic artery blood flow. In two cases (11.7%), an interposition iliac graft from the recipient supra-celiac aorta was used for the arterial reconstruction. During the follow-up period of up to 15 months, there was no incidence of hepatic artery thrombosis.
The clinical significance of the celiac compression syndrome is evident in liver transplantation in which the collateral circulation to the liver is compromised and the celiac artery remains the only source of arterial blood. It is imperative to identify and remove the obstruction of the celiac axis to prevent severe complications and potential graft loss.
作者评估了肝移植患者腹腔干压迫综合征的患病率及临床意义。
膈肌正中弓状韧带对腹腔干的压迫，会导致腹腔干血流减少，这可能会在原位肝移植患者中引发肝动脉血栓形成。
从1991年7月至1992年7月，在164例接受肝移植的成年连续患者中，确诊了17例（10%）腹腔干压迫综合征病例。通过血流记录证实诊断，该记录显示呼气时腹腔干血流明显减少的典型模式。
膈肌正中弓状韧带手术切断后，肝动脉血流恢复正常。2例（11.7%）采用取自受体腹腔干上方腹主动脉的髂血管移植进行动脉重建。在长达15个月的随访期内，未发生肝动脉血栓形成。
腹腔干压迫综合征的临床意义在肝移植中很明显，此时肝脏的侧支循环受损，腹腔干仍是动脉血的唯一来源。必须识别并消除腹腔干的梗阻，以预防严重并发症和潜在的移植物丢失。
