Inomoto T, Nishizawa F, Sasaki H, Terajima H, Shirakata Y, Miyamoto S, Nagata I, Fujimoto M, Moriyasu F, Tanaka K, Yamaoka Y
Second Department of Surgery, Faculty of Medicine, Kyoto University, Japan.
Surgery. 1996 Jan;119(1):20-6. doi: 10.1016/s0039-6060(96)80208-x.
We reviewed 120 microsurgical reconstructions of a hepatic artery in living related liver transplantation and discussed the problems encountered.
From January 1991 to July 1994 we performed a series of 105 living related liver transplantations on children with end-stage liver disease. Arterial reconstruction was performed under the optical field of a continuous zoom magnification of approximately 10 times with an operating microscope.
Twenty-six percent of the graft arteries were less than 2 mm in diameter. The time required for an arterial reconstruction was 49.5 +/- 1.8 minutes. In 15 of the 31 cases in which there were two graft arteries, two arterial reconstructions were required. The caliber differences between the graft artery and the recipient artery in 30 instances was dealt with by cutting an undersized artery obliquely (17 instances), by fish-mouth method (10 instances), by end-to-side anastomosis (1 instance), or by funnelization method (2 instances). In one case we performed an intimal dissection of a recipient hepatic artery and substituted a splenic artery. Consequently, hepatic arterial thrombosis occurred in only two cases (1.7%).
Microsurgical technique has overcome the high risk of hepatic arterial thrombosis in cases of fine graft arteries, enabled the reconstruction of arteries with caliber difference, and decreased arterial complications with its delicate manipulation.
我们回顾了120例活体亲属肝移植中肝动脉的显微外科重建，并讨论了所遇到的问题。
1991年1月至1994年7月，我们对患有终末期肝病的儿童进行了一系列105例活体亲属肝移植。在手术显微镜下，于约10倍的连续变焦放大视野下进行动脉重建。
26%的移植肝动脉直径小于2mm。动脉重建所需时间为49.5±1.8分钟。在31例有两根移植肝动脉的病例中，15例需要进行两次动脉重建。30例中移植肝动脉与受体动脉之间的管径差异通过以下方法处理：斜切较细的动脉（17例）、鱼口法（10例）、端侧吻合（1例）或漏斗化法（2例）。1例中我们对受体肝动脉进行了内膜剥离并代之以脾动脉。结果，仅2例（1.7%）发生了肝动脉血栓形成。
显微外科技术克服了移植肝动脉较细病例中肝动脉血栓形成的高风险，能够重建存在管径差异的动脉，并通过其精细操作减少了动脉并发症。
