Sano K, Makuuchi M, Takayama T, Sugawara Y, Imamura H, Kawarasaki H
Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan.
Hepatogastroenterology. 2000 Sep-Oct;47(35):1208-9.
In partial liver transplantation for adults criteria for the extent of reconstruction of middle hepatic vein tributaries have not been clarified. After hepatic venous and portal anastomoses in living-donor liver transplantation using left liver graft without middle hepatic vein, color Doppler ultrasonography was applied to check venous and portal blood flow. Color Doppler ultrasonography demonstrated absent hepatic venous flow and reversed portal venous flow in the congested area of the left paramedian sector which had been drained by the divided branch of the middle hepatic vein. The area was darkly discolored before arterial reperfusion and under clamping of the artery. Reconstruction of the venous branch was added after arterial anastomosis. Color Doppler ultrasonography revealed restored normal venous outflow and portal inflow after venous reconstruction. Postoperative course of the recipient was uneventful with rapid recovery of liver function. We propose that middle hepatic vein tributaries should be reconstructed if color Doppler ultrasonography demonstrates absent venous flow and reversed portal flow, and if the liver volume excluding the discolored area under occlusion of the hepatic artery is estimated to be insufficient for postoperative metabolic demand.
在成人部分肝移植中，肝中静脉分支重建范围的标准尚未明确。在使用无肝中静脉的左肝移植物进行活体肝移植时，进行肝静脉和门静脉吻合后，应用彩色多普勒超声检查静脉和门静脉血流。彩色多普勒超声显示，由肝中静脉分支引流的左旁正中扇形区充血区域无肝静脉血流，门静脉血流逆转。在动脉再灌注前和动脉夹闭时，该区域颜色深暗。动脉吻合后增加静脉分支重建。静脉重建后，彩色多普勒超声显示静脉流出和门静脉流入恢复正常。受者术后病程顺利，肝功能迅速恢复。我们建议，如果彩色多普勒超声显示无静脉血流和门静脉血流逆转，并且如果在肝动脉阻断下排除变色区域后的肝脏体积估计不足以满足术后代谢需求，则应重建肝中静脉分支。
