Ghobrial R M, Hsieh C B, Lerner S, Winters S, Nissen N, Dawson S, Amersi F, Chen P, Farmer D, Yersiz H, Busuttil R W
Department of Surgery, Division of Liver and Pancreas Transplantation, The Dumont-UCLA Transplant Center, Los Angeles, CA 90095-7054, USA.
Liver Transpl. 2001 Jun;7(6):551-5. doi: 10.1053/jlts.2001.24910.
A right lobe graft that is drained by the right hepatic vein (RHV) is obtained by transecting the liver on the right side of the middle hepatic vein (MHV). On occasion, a small RHV that only drains a portion of the right lobe, with the predominant outflow achieved by the MHV, is encountered. If such variation is not recognized while performing right lobe liver transplantation and the RHV only is used for reconstruction, venous outflow obstruction with subsequent graft congestion and eventual graft failure will occur. Additionally, preservation of the main MHV and its branch drainage of the left lobe is crucial to avoid outflow blockage to the remaining segment 4 in the donor. We report 4 cases showing a variant type of small RHV and large MHV branch that drain not only segments 5 and 8, but also segments 6 and 7. These variations were simultaneously associated with a large-caliber inferior RHV that also required reconstruction. The methods used to diagnose such anatomic variations and the techniques for reconstruction in the donor and recipient are described.
通过在肝中静脉（MHV）右侧横断肝脏来获取由右肝静脉（RHV）引流的右叶移植物。偶尔会遇到一种小的RHV，它仅引流右叶的一部分，主要的流出道由MHV实现。如果在进行右叶肝移植时未识别出这种变异，而仅使用RHV进行重建，将会发生静脉流出道梗阻，随后移植物充血并最终导致移植物失败。此外，保留左叶的主要MHV及其分支引流对于避免供体中剩余的第4段出现流出道阻塞至关重要。我们报告了4例显示一种变异类型的小RHV和大的MHV分支的病例，它们不仅引流第5段和第8段，还引流第6段和第7段。这些变异同时伴有一条大口径的肝右下静脉，也需要进行重建。描述了用于诊断此类解剖变异的方法以及供体和受体的重建技术。
