Kaneko T, Kaneko K, Sugimoto H, Inoue S, Hatsuno T, Sawada K, Ando H, Nakao A
Department of Surgery II and Pediatric Surgery, Faculty of Medicine, University of Nagoya, Japan.
Transplantation. 2000 Sep 27;70(6):982-5. doi: 10.1097/00007890-200009270-00018.
In living related liver transplantation, the right lobe has come to be used as a graft to meet the metabolic demands of adult or adolescent recipients. In harvesting the right lobe as a graft, however, there is controversy as to whether or not the middle hepatic vein (MHV) should be included and reconstructed. Anatomical intrahepatic anastomosis between the right hepatic vein (RHV) and MHV is considered to exist, but the formation process of this functional anastomosis has not been demonstrated by Doppler ultrasonography (US). In our case, a right lobe including a right branch of the MHV was used as a graft. In implanting, the RHV was anastomosed to the inferior vena cava and the right branch of the MHV was ligated. Using Doppler US, we checked the blood flow in the hepatic vein after transplantation. Within 3 days of surgery, no flow was detected in the right branch of the MHV. A flow around the right branch of the MHV was observed at postoperative day 6. At postoperative day 9, a reverse flow was detected in which the right branch of the MHV drained into the RHV via the anastomosis between them. Based on our results, it appears that a functional intrahepatic anastomosis between hepatic veins formed gradually within 10 days of ligation of an afferent branch, during which time the graft function did not deteriorate.
在活体亲属肝移植中，右叶已被用作移植物以满足成年或青少年受者的代谢需求。然而，在切取右叶作为移植物时，对于是否应包含并重建肝中静脉（MHV）存在争议。肝右静脉（RHV）与MHV之间的肝内解剖学吻合被认为是存在的，但这种功能性吻合的形成过程尚未通过多普勒超声（US）得到证实。在我们的病例中，包含MHV右支的右叶被用作移植物。在植入时，将RHV与下腔静脉吻合，并结扎MHV的右支。我们使用多普勒超声检查了移植后肝静脉中的血流情况。术后3天内，未在MHV右支中检测到血流。术后第6天观察到MHV右支周围有血流。术后第9天，检测到逆向血流，即MHV右支通过它们之间的吻合口流入RHV。根据我们的结果，似乎在结扎传入分支后的10天内，肝静脉之间的功能性肝内吻合逐渐形成，在此期间移植物功能并未恶化。
