Kaneoka Y, Yamaguchi A, Isogai M, Hori A
Department of Surgery, Ogaki Municipal Hospital, Minaminokawa-cho, Ogaki 503-0864, Japan.
World J Surg. 2000 Mar;24(3):377-82. doi: 10.1007/s002689910060.
The utility of hepatic vein reconstruction following resection of segments VII and VIII plus the right hepatic vein (RHV) is still controversial. The purpose of this study was to investigate the surgical benefits of hepatic vein reconstruction using stapled vascular clips and the draining area of hepatic vein using angiographic computed tomography (CT) to determine strict indications for hepatic vein reconstruction. Five patients underwent RHV reconstruction by external iliac vein graft using stapled vascular clips (VCS clips) following resection of segments VII and VIII, regardless of whether an inferior right hepatic vein (IRHV) was present. In eight other patients CT during arterial portography (CTAP) under temporary RHV occlusion using a balloon catheter was performed to determine the drainage area of the RHV. Operating times were 240 to 400 minutes (mean 336 +/- 59 minutes), and the mean hepatic vein reconstruction time was 26 +/- 5 minutes. There were no complications related to the surgery. Follow-up examinations showed patency of the graft in all cases; three patients are still alive with long-term graft patency of 10 to 24 months. CTAP under RHV occlusion demonstrated that segment VI and part of segment V were almost hypoattenuated in cases of absent or small IRHV, although those segments were hyperattenuated in thick IRHV and RHV-IRHV communicating patients. In conclusion, this anastomotic technique using vascular clips resulted in sound patency of the graft, which was accomplished by a simple technique. Preoperative CT AP with the RHV occlusion method can be useful for determining whether hepatic vein reconstruction is necessary.
在切除肝段VII和VIII以及右肝静脉（RHV）后进行肝静脉重建的效用仍存在争议。本研究的目的是探讨使用吻合器血管夹进行肝静脉重建的手术益处，以及利用血管造影计算机断层扫描（CT）确定肝静脉的引流区域，以明确肝静脉重建的严格适应证。5例患者在切除肝段VII和VIII后，无论是否存在右下肝静脉（IRHV），均使用吻合器血管夹（VCS夹）通过髂外静脉移植进行RHV重建。另外8例患者在使用球囊导管暂时阻断RHV的情况下进行动脉门静脉造影（CTAP）时行CT检查，以确定RHV的引流区域。手术时间为240至400分钟（平均336 +/- 59分钟），平均肝静脉重建时间为26 +/- 5分钟。未发生与手术相关的并发症。随访检查显示所有病例中移植血管均通畅；3例患者仍存活，移植血管长期通畅时间为10至24个月。RHV阻断下的CTAP显示，在无IRHV或IRHV较小的情况下，肝段VI和部分肝段V几乎呈低密度，而在IRHV粗大且RHV与IRHV相通的患者中，这些肝段呈高密度。总之，这种使用血管夹的吻合技术使移植血管通畅良好，且该技术操作简单。采用RHV阻断法的术前CTAP有助于确定是否有必要进行肝静脉重建。
