• 第二軍醫(yī)大學(xué)東方肝膽外科醫(yī)院膽道一科（上海200438）;

目的 　研究肝移植受體肝動(dòng)脈解剖變異、病理異常與吻合部位選擇的關(guān)系。
方法 　回顧性分析2004年3月至2006年7月期間我院80例成人肝移植患者的臨床資料。術(shù)前磁共振血管成像結(jié)合術(shù)中動(dòng)脈解剖鑒別動(dòng)脈變異、病理異常及其類型，記錄動(dòng)脈吻合部位和口徑，對(duì)動(dòng)脈解剖變異組與無(wú)變異組的吻合部位和吻合口直徑進(jìn)行比較。
結(jié)果 　全組受體肝動(dòng)脈解剖變異率為11.3%(9/80)，肝右動(dòng)脈變異8/9例，分別來(lái)自胃十二指腸動(dòng)脈(GDA)、肝總動(dòng)脈(CHA)、腹腔動(dòng)脈或腸系膜上動(dòng)脈。吻合部位為CHA(7/9例)或GDA(2/9例)分支袖片。病理異常為2例，其中肝動(dòng)脈內(nèi)、外膜分離1例，以CHA端吻合； 肝動(dòng)脈狹窄1例，選擇腎上腹主動(dòng)脈前壁吻合。解剖變異組與無(wú)變異組吻合部位差異有統(tǒng)計(jì)學(xué)意義(χ2=18.679, P＜0.01)，解剖變異組CHA分支袖片吻合口徑與無(wú)變異組肝固有動(dòng)脈或CHA分支袖片比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(P gt;0.05)。
結(jié)論 　受體肝動(dòng)脈解剖變異影響吻合部位選擇，CHA分支袖片是首選部位； 無(wú)變異組肝固有動(dòng)脈分支袖片與變異組CHA分支袖片的吻合口徑相似，前者可作為無(wú)動(dòng)脈變異時(shí)的常用吻合部位。

引用本文： 易濱,于勇,羅祥基,譚蔚鋒,劉晨,姜小清,張柏和. 肝移植受體肝動(dòng)脈異常的診斷及處理. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008, 15(10): 756-760. doi: 復(fù)制

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2. 　Aramaki O, Sugawara Y, Kokudo N, et al. Branch patch reconstruction in living donor liver transplantation: arterialization of grafts with replaced type arteries [Ｊ]. Transplantation, 2006; 82(11)∶1541.
3. 　易濱, 姜小清, 張柏和, 等. 80例成人肝移植的供肝動(dòng)脈變異、損傷與植入前重建 [Ｊ]. 復(fù)旦學(xué)報(bào)(醫(yī)學(xué)版), 2007; 34(6)∶828.
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5. 　易濱, 于勇, 羅祥基, 等. 袖片技術(shù)在成人肝移植動(dòng)脈重建中的應(yīng)用 [Ｊ]. 中國(guó)組織工程研究與臨床康復(fù), 2008； 12(31)∶6011.
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8. 　Soin AS, Friend PJ, Rasmussen A, et al. Donor arterial variations in liver transplantation: management and outcome of 527 consecutive grafts [Ｊ]. Br J Surg, 1996; 83(5)∶637.
9. 　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.
10. 　Koops A, Wojciechowski B, Broering DC, et al. Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies [Ｊ]. Surg Radiol Anat, 2004; 26(3)∶239.
11. 　Ferraz-Neto BH, Meira-Filho SR, Hidalgo R, et al. Correlation between graft arterial anatomy and biliary complications after liver transplantation [Ｊ]. Transplant Proc, 2007; 39(8)∶2514.
12. 　楊揚(yáng), 姜楠, 陸敏強(qiáng), 等. 843例肝移植供肝動(dòng)脈的解剖變異分析 [Ｊ]. 南方醫(yī)科大學(xué)學(xué)報(bào), 2007; 27(8)∶1164.
13. 　宋世兵, 袁炯, 修典榮, 等. 原位肝移植術(shù)中肝動(dòng)脈變異及術(shù)后肝動(dòng)脈血栓形成的處理 [Ｊ]. 中華器官移植雜志, 2004; 25(6)∶336.
14. 　戴小明, 葉啟發(fā), 齊海智, 等. 肝動(dòng)脈變異與肝移植 [Ｊ]. 中國(guó)現(xiàn)代手術(shù)學(xué)雜志, 2006; 10(3)∶179.
15. 　Karakayali H, Ozcay F, Sevmis S, et al. Liver transplantation for small babies [Ｊ]. Transplant Proc, 2007; 39(4)∶1153.
16. 　朱曉峰, 何曉順, 馬毅, 等. 原位肝移植中受體血管異常時(shí)的肝動(dòng)脈重建 [Ｊ]. 中國(guó)普通外科雜志, 2005; 14(2)∶118.
17. 　冉江華, 張升寧, 李鑄, 等. 肝動(dòng)脈-腹主動(dòng)脈搭橋在原位肝移植術(shù)中的應(yīng)用 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(2)∶102.
18. 　張升寧, 李立, 冉江華, 等. 原位肝移植術(shù)中動(dòng)脈重建及術(shù)后并發(fā)癥的防治 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007; 14(5)∶ 564.
19. 　嚴(yán)律南. 成人間活體肝移植的外科技術(shù)與創(chuàng)新 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(3)∶151.
20. 　Wang CC, Lin TS, Chen CL, et al. Arterial reconstruction in hepatic artery occlusions in adult living donor liver transplantation using gastric vessels [Ｊ]. Surgery, 2008; 143(5)∶686.
21. 　D’Albuquerque LA, Gonzalez AM, Letrinda RF, et al. Use of the splenic artery for arterial reconstruction in living donor liver transplantation [Ｊ]. Transplant Proc, 2007; 39(10)∶3202.
  1. 1. 　Takatsuki M, Chiang YC, Lin TS, et al. Anatomical and technical aspects of hepatic artery reconstruction in living donor liver transplantation [Ｊ]. Surgery, 2006; 140(5)∶824.
  2. 2. 　Aramaki O, Sugawara Y, Kokudo N, et al. Branch patch reconstruction in living donor liver transplantation: arterialization of grafts with replaced type arteries [Ｊ]. Transplantation, 2006; 82(11)∶1541.
  3. 3. 　易濱, 姜小清, 張柏和, 等. 80例成人肝移植的供肝動(dòng)脈變異、損傷與植入前重建 [Ｊ]. 復(fù)旦學(xué)報(bào)(醫(yī)學(xué)版), 2007; 34(6)∶828.
  4. 4. 　Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation [Ｊ]. Am J Surg, 1966; 112(3)∶ 337.
  5. 5. 　易濱, 于勇, 羅祥基, 等. 袖片技術(shù)在成人肝移植動(dòng)脈重建中的應(yīng)用 [Ｊ]. 中國(guó)組織工程研究與臨床康復(fù), 2008； 12(31)∶6011.
  6. 6. 　Mehrabi A, Fonouni H, Müller SA, et al. Current concepts in transplant surgery: liver transplantation today [Ｊ]. Langenbecks Arch Surg, 2008; 393(3)∶245.
  7. 7. 　Hiatt JR, Gabbay J, Busuttil RW, et al. Surgical anatomy of the hepatic arteries in 1 000 cases [Ｊ]. Ann Surg, 1994; 220(1)∶50.
  8. 8. 　Soin AS, Friend PJ, Rasmussen A, et al. Donor arterial variations in liver transplantation: management and outcome of 527 consecutive grafts [Ｊ]. Br J Surg, 1996; 83(5)∶637.
  9. 9. 　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.
  10. 10. 　Koops A, Wojciechowski B, Broering DC, et al. Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies [Ｊ]. Surg Radiol Anat, 2004; 26(3)∶239.
  11. 11. 　Ferraz-Neto BH, Meira-Filho SR, Hidalgo R, et al. Correlation between graft arterial anatomy and biliary complications after liver transplantation [Ｊ]. Transplant Proc, 2007; 39(8)∶2514.
  12. 12. 　楊揚(yáng), 姜楠, 陸敏強(qiáng), 等. 843例肝移植供肝動(dòng)脈的解剖變異分析 [Ｊ]. 南方醫(yī)科大學(xué)學(xué)報(bào), 2007; 27(8)∶1164.
  13. 13. 　宋世兵, 袁炯, 修典榮, 等. 原位肝移植術(shù)中肝動(dòng)脈變異及術(shù)后肝動(dòng)脈血栓形成的處理 [Ｊ]. 中華器官移植雜志, 2004; 25(6)∶336.
  14. 14. 　戴小明, 葉啟發(fā), 齊海智, 等. 肝動(dòng)脈變異與肝移植 [Ｊ]. 中國(guó)現(xiàn)代手術(shù)學(xué)雜志, 2006; 10(3)∶179.
  15. 15. 　Karakayali H, Ozcay F, Sevmis S, et al. Liver transplantation for small babies [Ｊ]. Transplant Proc, 2007; 39(4)∶1153.
  16. 16. 　朱曉峰, 何曉順, 馬毅, 等. 原位肝移植中受體血管異常時(shí)的肝動(dòng)脈重建 [Ｊ]. 中國(guó)普通外科雜志, 2005; 14(2)∶118.
  17. 17. 　冉江華, 張升寧, 李鑄, 等. 肝動(dòng)脈-腹主動(dòng)脈搭橋在原位肝移植術(shù)中的應(yīng)用 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(2)∶102.
  18. 18. 　張升寧, 李立, 冉江華, 等. 原位肝移植術(shù)中動(dòng)脈重建及術(shù)后并發(fā)癥的防治 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007; 14(5)∶ 564.
  19. 19. 　嚴(yán)律南. 成人間活體肝移植的外科技術(shù)與創(chuàng)新 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(3)∶151.
  20. 20. 　Wang CC, Lin TS, Chen CL, et al. Arterial reconstruction in hepatic artery occlusions in adult living donor liver transplantation using gastric vessels [Ｊ]. Surgery, 2008; 143(5)∶686.
  21. 21. 　D’Albuquerque LA, Gonzalez AM, Letrinda RF, et al. Use of the splenic artery for arterial reconstruction in living donor liver transplantation [Ｊ]. Transplant Proc, 2007; 39(10)∶3202.