Marwan I K, Fawzy A T, Egawa H, Inomata Y, Uemoto S, Asonuma K, Kiuchi T, Hayashi M, Fujita S, Ogura Y, Tanaka K
Department of Transplantation Immunology, Faculty of Medicine, Kyoto University, Japan.
Surgery. 1999 Mar;125(3):265-70.
Portal vein reconstruction is a crucial factor affecting the outcome of a successful living-related liver transplantation. We describe here our experience with portal vein reconstruction in 314 cases of living-related liver transplantation with use of novel surgical modalities to enable the transplant surgeons to deal with any size mismatch between the donor's and recipient's portal veins.
Portal vein reconstruction was classified into 2 major groups, anastomosis without and with a vein graft. When there was no stenosis of the recipient portal vein and the diameter was the same, the portal trunk was used for anastomosis. When the diameter mismatch was minimal, branch patch anastomosis was feasible. When the recipient portal vein was significantly stenotic and the portal vein of the graft was long enough, we removed the stenotic trunk and constructed an anastomosis between the graft portal vein and the confluence of the recipient portal vein. When the graft portal vein was short, a vein graft was interposed. The vein patch technique was preferable when the diameter of the graft vein was not large enough for the interposition technique.
Anastomosis without vein graft included trunk anastomosis (n = 156), branch patch anastomosis (n = 39), and confluence anastomosis (n = 22). Anastomosis with vein graft used the interposition technique (n = 77) and vein patch technique (n = 27). The origin of the grafts was mostly from the maternal left ovarian vein (70%) or the paternal inferior mesenteric vein (27%). Complications related to portal vein reconstruction occurred in 16 (5%) patients: portal vein thrombosis in 8, stenosis in 7, and fatal rupture in 1 patient. The incidence of complications was similar for all techniques except for confluence anastomosis.
Our innovative techniques should be helpful for overcoming diameter or length mismatches in portal vein reconstruction in pediatric liver transplantation.
门静脉重建是影响亲体肝移植成功结局的关键因素。在此，我们描述了314例亲体肝移植中门静脉重建的经验，采用了新颖的手术方式，以使移植外科医生能够应对供体和受体门静脉之间的任何尺寸不匹配问题。
门静脉重建分为两大类，即无静脉移植物吻合和有静脉移植物吻合。当受体门静脉无狭窄且直径相同时，使用门静脉主干进行吻合。当直径不匹配很小时，可行分支补片吻合。当受体门静脉明显狭窄且移植物门静脉足够长时，我们切除狭窄的主干，在移植物门静脉与受体门静脉汇合处之间进行吻合。当移植物门静脉较短时，插入静脉移植物。当移植物静脉直径不足以进行插入技术时，静脉补片技术更为可取。
无静脉移植物吻合包括主干吻合（n = 156）、分支补片吻合（n = 39）和汇合处吻合（n = 22）。有静脉移植物吻合采用插入技术（n = 77）和静脉补片技术（n = 27）。移植物的来源主要是母体左卵巢静脉（70%）或父体肠系膜下静脉（27%）。16例（5%）患者发生了与门静脉重建相关的并发症：门静脉血栓形成8例，狭窄7例，1例患者发生致命破裂。除汇合处吻合外，所有技术的并发症发生率相似。
我们的创新技术应有助于克服小儿肝移植中门静脉重建中的直径或长度不匹配问题。
