Prevention and treatment of hepatic artery dissection in donors and recipients during liver transplantation
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摘要: 肝动脉重建是肝移植术中关键操作步骤之一，供受者因素及手术操作因素导致术中出现待重建动脉意外形成夹层的情况会打乱手术计划，增加动脉重建难度，明显延长手术时间，增加术后动脉狭窄及血栓的风险，也可能导致急性移植物失功而需要紧急手术干预甚至二次肝移植。探讨如何避免肝移植术中待吻合动脉形成夹层以及待吻合动脉出现夹层后的处理，将有助于预防肝移植术中动脉相关并发症，改善肝移植受者的预后。本文就肝移植术中供受者肝动脉夹层的成因、预防、处理及肝动脉重建方式经验介绍如下。Abstract: Hepatic artery reconstruction is one of the key procedures in liver transplantation. Accidental dissection of the hepatic artery to be reconstructed caused by donor and recipient factors or surgical factors will disrupt the surgical plan, increase the difficulty of arterial reconstruction, significantly prolong the operation time, increase the risk of postoperative arterial stenosis and thrombosis and probably lead to acute allograft failure, which requires emergency surgical interventions or even secondary liver transplantation. Understanding of how to avoid dissection of the artery to be anastomosed during liver transplantation and corresponding treatment will contribute to preventing the incidence of artery-related complications during liver transplantation and improving clinical prognosis of liver transplant recipients. In this article, the causes, prevention and treatment of hepatic artery dissection and hepatic artery reconstruction in donors and recipients during liver transplantation were illustrated.
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图 1 不同血管残端处理方式对动脉夹层的影响
注：A图示结扎线收紧后动脉内膜收缩幅度更大，卷曲成花瓣状，导致多处内外膜分离（红色箭头）；B图示剪开结扎线结，纵向剖开动脉，可见动脉内膜结扎线明显切割痕迹（红色箭头），痕迹远端动脉内外膜分离明显；C图示Hem-o-lok夹闭动脉后可见内膜挤出，但无花瓣状及内外膜分离表现（红色箭头）；D图示去除Hem-o-lok夹，纵向剖开动脉，可见动脉内膜夹闭处明显切割痕迹（红色箭头），痕迹两侧内膜较为完整。
Figure 1. Influence of different treatment methods for vascular stump on arterial dissection
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