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肝移植供肝动脉变异与重建方式对术后早期动脉并发症的影响

何博 王新 王峰 孙延东 徐庆国 关鸽 臧运金

何博, 王新, 王峰, 等. 肝移植供肝动脉变异与重建方式对术后早期动脉并发症的影响[J]. 临床肝胆病杂志, 2021, 37(8): 1901-1904. DOI: 10.3969/j.issn.1001-5256.2021.08.030
引用本文: 何博, 王新, 王峰, 等. 肝移植供肝动脉变异与重建方式对术后早期动脉并发症的影响[J]. 临床肝胆病杂志, 2021, 37(8): 1901-1904. DOI: 10.3969/j.issn.1001-5256.2021.08.030
HE B, WANG X, WANG F, et al. Influence of arterial variation and reconstruction of the donor hepatic artery in liver transplantation on early postoperative arterial complications[J]. J Clin Hepatol, 2021, 37(8): 1901-1904. DOI: 10.3969/j.issn.1001-5256.2021.08.030
Citation: HE B, WANG X, WANG F, et al. Influence of arterial variation and reconstruction of the donor hepatic artery in liver transplantation on early postoperative arterial complications[J]. J Clin Hepatol, 2021, 37(8): 1901-1904. DOI: 10.3969/j.issn.1001-5256.2021.08.030

肝移植供肝动脉变异与重建方式对术后早期动脉并发症的影响

DOI: 10.3969/j.issn.1001-5256.2021.08.030
基金项目: 

恒瑞肝胆胰恶性肿瘤研究基金 CXPJJH11800001-2018320

DCD时代肝移植技术开发与创新 2019GSF108266

详细信息
    通讯作者:

    臧运金,zangyj3657@qq.com

  • 中图分类号: R617

Influence of arterial variation and reconstruction of the donor hepatic artery in liver transplantation on early postoperative arterial complications

Funds: 

Hengrui Hepatobiliary Pancreatic Cancer Research Foundation CXPJJH11800001-2018320

Development and Innovation of Liver Transplantation Technology in DCD Era 2019GSF108266

  • 图  1  供肝动脉解剖类型

    注:a, 正常型; b, aRHA1发自SMA; c, aLHA发自LGA; d, CHA发自SMA; e, PHA发自SMA; f, aRHA发自SMA并aLHA发自LGA; g, aRHA发自CT; h, rRHA发自SMA并aLHA发自CT; i, aLHA发自GDA。

    图  2  肝移植术中动脉重建方式

    注:a、b, 正常型; c、d、e、f,aRHA发自SMA;g, aLHA发自LGA; h, CHA或PHA发自SMA; iaRHA发自SMA并aLHA发自LGA; j, aRHA发自CT; k, rRHA发自SMA并aLHA发自CT; l, aLHA发自GDA。

    表  1  415例肝移植患者临床资料

    项目 所有患者
    (n=415)
    变异组
    (n=68)
    非变异组
    (n=347)
    统计值 P
    男/女(例) 333/82 56/12 277/70 χ2=0.09 0.75
    年龄(岁) 51.7±10.0 50.9±10.5 51.9±9.9 t=0.70 0.48
    BMI(kg/m2) 24.41±7.28 24.59±3.61 24.38±3.84 t=0.43 0.67
    MELD评分 9.0(4.1~15.0) 9.8(5.7~15.5) 8.4(3.6~15.0) Z=0.27 0.27
    冷缺血(min) 371.4±133.8 398.4±158.2 365.3±131.5 t=1.51 0.13
    手术时间(min) 517.9±129.6 519.7±99.7 517.0±135.5 t=0.15 0.88
    手术方式(例) χ2=1.03 0.31
      经典肝移植术 366 57 309
      背驮式肝移植术 49 11 38
    原发病(例) χ2=10.21 0.08
      原发性肝癌 216 35 181
      肝炎后肝硬化 125 18 107
      酒精性肝硬化 23 1 22
      自身免疫性肝病 26 5 21
      其他1) 25 9 16
    注:1)包括急性肝衰竭、肝小静脉闭塞综合征、布加综合征、药物性肝硬化、多囊肝、肝移植术胆道并发症、多囊肝、肝豆状核变性。
    下载: 导出CSV

    表  2  415例供肝动脉的解剖分型术中动脉具体重建方式

    解剖类型 例(%) HIATT分型 重建方式
    正常型 347(83.61) 将供肝CT或将SA和CHA分叉修整成袖片与受者GDA及CHA分叉做端端吻合(图 2a);
    使用供体髂动脉(Iliac artery,ⅠA)架桥,一端与受者腹主动脉(Abdominal aorta,AA)吻合,另一端与供肝CHA吻合3例(图 2b)
    aRHA发自SMA 41(9.88) 将供体aRHA与供肝SA或GDA端端吻合, 再将供肝CT与受者GDA和CHA分叉做端端吻合(图 2c2d);
    供受体均有aRHA,将其端端吻合,再将供肝CT与受者GDA和CHA分叉做端端吻合(图 2e);
    将供肝SMA一端与供肝CT端端吻合,另一端与受者GDA和CHA分叉端端吻合(图 2f)
    aLHA发自LGA 8(1.93) 将供肝CT与受者GDA和CHA分叉做端端吻合(图 2g)
    CHA发自SMA 4(0.96) 将肝动脉与SMA分叉修整成袖片,与受者GDA和CHA分叉做端端吻合(图 2h)
    PHA发自SMA 5(1.20)
    aRHA发自SMA并aLHA发自LGA 6(1.45) 将供肝aRHA与供肝SA做端端吻合,再将供肝CT与受者GDA及CHA分叉做端端吻合(图 2i)
    aRHA发自CT 2(0.48) 将供肝CT与受者GDA和CHA分叉做端端吻合(图 2j)
    rRHA发自SMA并aLHA发自CT 1(0.24) 将供肝SMA远端与供肝CT作端端吻合,再将供肝SMA近端与受者GDA和CHA分叉做端端缝合(图 2k)
    aLHA发自GDA 1(0.24) 将供肝CT与受者GDA和CHA分叉做端端吻合(图 2l)
    注:aRHA,副肝右动脉;SMA,肠系膜上动脉;aLHA, 副肝左动脉;rRHA,替代肝右动脉。
    下载: 导出CSV

    表  3  不同重建方式与动脉并发症的关系

    并发症 供体侧重建方式 受体侧重建方式 复杂重建
    (n=50)
    普通重建
    (n=365)
    P
    CT或CHA/SA分叉(n=395) CHA或PHA
    (n=20)
    P CHA/GDA分叉
    (n=391)
    CHA
    (n=15)
    RHA/LHA分叉
    (n=9)
    P
    10 1 0.40 10 1 0 0.48 3 8 0.13
    385 19 381 14 9 47 357
    下载: 导出CSV
  • [1] LI MX, PENG GZ, YE QF. Progress of hepatic artery complications after liver transplantation[J]. J Hepatopancreatobiliary Surg, 2016, 28(3): 251-254. DOI: 10.11952/j.issn.1007-1954.2016.03.024.

    李明霞, 彭贵主, 叶啟发. 肝移植术后肝动脉并发症研究进展[J]. 肝胆胰外科杂志, 2016, 28(3): 251-254. DOI: 10.11952/j.issn.1007-1954.2016.03.024.
    [2] KARAKOYUN R, ROMANO A, YAO M, et al. Impact of hepatic artery variations and reconstructions on the outcome of orthotopic liver transplantation[J]. World J Surg, 2020, 44(6): 1954-1965. DOI: 10.1007/s00268-020-05406-4.
    [3] WARNER P, FUSAI G, GLANTZOUNIS GK, et al. Risk factors associated with early hepatic artery thrombosis after orthotopic liver transplantation univariable and multivariable analysis[J]. Transpl Int, 2011, 24(4): 401-408. DOI: 10.1111/j.1432-2277.2010.01211.x.
    [4] SOLIMAN T, BODINGBAUER M, LANGER F, et al. The role of complex hepatic artery reconstruction in orthotopic liver transplantation[J]. Liver Transpl, 2003, 9(9): 970-975. DOI: 10.1053/jlts.2003.50167.
    [5] HERRERO A, SOUCHE R, JOLY E, et al. Early hepatic artery thrombosis after liver transplantation: What is the impact of the arterial reconstruction type?[J]. World J Surg, 2017, 41(8): 2101-2110. DOI: 10.1007/s00268-017-3989-4.
    [6] SOLIMAN T, BODINGBAUER M, LANGER F, et al. The role of complex hepatic artery reconstruction in orthotopic liver transplantation[J]. Liver Transpl, 2003, 9(9): 970-975. DOI: 10.1053/jlts.2003.50167.
    [7] ZHANG H, GU LH, XIA Q. Application and progress of contrast-enhanced ultrasound in the diagnosis of complications after liver transplantation[J]. Chin Hepatol, 2017, 22(1): 72-75. DOI: 10.3969/j.issn.1008-1704.2017.01.024.

    张赫, 顾莉红, 夏强. 超声造影在肝移植术后并发症诊断中的应用及进展[J]. 肝脏, 2017, 22(1): 72-75. DOI: 10.3969/j.issn.1008-1704.2017.01.024.
    [8] FUJIKI M, HASHIMOTO K, PALAIOS E, et al. Probability, management, and long-term outcomes of biliary complications after hepatic artery thrombosis in liver transplant recipients[J]. Surgery, 2017, 162(5): 1101-1111. DOI: 10.1016/j.surg.2017.07.012.
    [9] XUE Z, CHEN M, ZHANG X, et al. Analysis of early hepatic artery thrombosis after liver transplantation[J]. ANZ J Surg, 2018, 88(3): 172-176. DOI: 10.1111/ans.13911.
    [10] SONG S, KWON CH, MOON HH, et al. Single-center experience of consecutive 522 cases of hepatic artery anastomosis in living-donor liver transplantation[J]. Transplant Proc, 2015, 47(6): 1905-1911. DOI: 10.1016/j.transproceed.2015.06.014.
    [11] YANG Y, ZHAO JC, YAN LN, et al. Risk factors associated with early and late HAT after adult liver transplantation[J]. World J Gastroenterol, 2014, 20(30): 10545-10552. DOI: 10.3748/wjg.v20.i30.10545.
    [12] ALGARNI AA, MOURAD MM, BRAMHALL SR. Anticoagulation and antiplatelets as prophylaxis for hepatic artery thrombosis after liver transplantation[J]. World J Hepatol, 2015, 7(9): 1238-1243. DOI: 10.4254/wjh.v7.i9.1238.
    [13] CHENG YF, OU HY, YU CY, et al. Interventional radiology in living donor liver transplant[J]. World J Gastroenterol, 2014, 20(20): 6221-6225. DOI: 10.3748/wjg.v20.i20.6221.
    [14] TRONINA O, MIKOȽAJCZYK N, PIETRZAK B, et al. Pregnancy in a patient with hepatic artery thrombosis after liver transplantation: A case report[J]. Transplant Proc, 2014, 46(8): 2929-2931. DOI: 10.1016/j.transproceed.2014.09.021.
    [15] CHEN C, GAO J, HU LB. Interventional diagnosis and treatment of hepatic artery complications after liver transplantation[J]. China Med, 2015, 10(10): 1478-1480. DOI: 10.3760/cma.j.issn.1673-4777.2015.10.019.

    陈尘, 高建, 胡立宝. 肝移植术后肝动脉并发症的介入诊断与治疗[J]. 中国医药, 2015, 10(10): 1478-1480. DOI: 10.3760/cma.j.issn.1673-4777.2015.10.019.
    [16] RINALDI P, INCHINGOLO R, GIULIANI M, et al. Hepatic artery stenosis in liver transplantation: Imaging and interventional treatment[J]. Eur J Radiol, 2012, 81(6): 1110-1115. DOI: 10.1016/j.ejrad.2011.02.055.
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  • 收稿日期:  2020-12-15
  • 修回日期:  2021-02-15
  • 刊出日期:  2021-08-16
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