DCD供肝全肝移植中变异肝动脉的评估和处理现状

Current status of assessment and management of variant hepatic arteries in DCD liver transplantation

摘要:

心脏死亡捐献供肝全肝移植（DCD-LT）是终末期肝病的根治性治疗手段，但肝动脉解剖变异在移植中十分常见，若处理不当可导致供肝局部供血不足及移植物功能障碍。如何精准处理变异肝动脉仍是手术成功的关键难点。本文综述了基于Michels等分型的多种解剖学分类体系，阐述了影像学技术在DCD-LT中对变异肝动脉的评估及术中决策价值，并总结了外科手术的主要处理方式。重点探讨了复杂变异动脉重建的标准化策略，并提出未来研究方向，以期为DCD-LT中变异肝动脉的评估和处理提供参考。

Abstract:

Donation after circulatory death liver transplantation (DCD-LT) remains a curative treatment for end-stage liver disease. Variant hepatic arteries are frequently encountered during transplantation, and inadequate management may result in localized ischemia and graft dysfunction. Precise handling of these variations remains a critical determinant of surgical success. This review summarizes anatomical classifications based on Michels' typology, highlights the value of imaging modalities in preoperative evaluation and intraoperative decision-making, and outlines current surgical approaches. Particular emphasis is placed on standardized strategies for arterial reconstruction in complex variations. Future research perspectives are also proposed, aiming to optimize assessment and management of variant hepatic arteries in DCD-LT.