Gyu Lee Sung, Min Park Kwang, Hwang Shin, Hun Kim Ki, Nak Choi Dong, Hyung Joo Sun, Soo Anh Chul, Won Nah Yang, Yeong Jeon Jang, Hoon Park Sang, Suck Koh Kyung, Hoon Han Sang, Taek Choi Kyu, Sam Hwang Kyu, Sugawara Yasuhiko, Makuuchi Masatoshi, Chul Min Pyung
Department of General Surgery, Asan Medical Center, Ulsan University, Seoul, Korea.
Transplantation. 2002 Jul 15;74(1):54-9. doi: 10.1097/00007890-200207150-00010.
Right liver grafts without middle hepatic vein (MHV) drainage reconstruction resulted in severe congestion of the anterior segment (AS) in our early experience of adult-to-adult living donor liver transplantation (LDLT). However, a detailed strategy for preventing such congestion or the necessity of MHV reconstruction has not been discussed in LDLT using a right lobe graft.
From July 1997 to February 1998, two of five right lobe grafts without MHV drainage reconstruction were complicated with severe congestion of the AS. Thereafter, 42 adult recipients who received right liver grafts with sizable MHV tributaries underwent the reconstruction of MHV drainage. All sizable (>5 mm in diameter) MHV tributaries were preserved during donor hepatectomy and were reconstructed with the recipient's autogenous interposition vein grafts at the bench surgery. The reconstructed vein grafts of this modified right lobe graft were anastomosed to the stump of the MHV and/or left hepatic vein of the recipient after graft revascularization.
Serial Doppler ultrasonography, which was regularly checked until 30 days posttransplant, revealed the patent interposition vein graft in 38 of 42 recipients (patency rate 90.5%). In these 38 recipients, no evidence of congestion in the AS was recognized on enhanced computed tomography, while providing enough functioning liver mass comparable to an extended right lobe graft. Also, congestion-related graft injury, such as an infarct of the AS, was not observed in these recipients.
Our early experience indicated the necessity of MHV drainage reconstruction in right lobe grafts, which do not have MHV trunk in certain instances. However, preoperatively, it is difficult to predict the degree of AS congestion of the right liver graft without MHV drainage reconstruction. We suggest aggressive reconstruction of MHV drainage tributaries of the AS, under the circumstances that sizable MHV tributaries are encountered, to prevent possible congestion-related complications.
在我们成人对成人活体肝移植（LDLT）的早期经验中，没有进行肝中静脉（MHV）引流重建的右肝移植物导致前段（AS）严重充血。然而，在使用右叶移植物的LDLT中，尚未讨论预防这种充血的详细策略或MHV重建的必要性。
1997年7月至1998年2月，五例未进行MHV引流重建的右叶移植物中有两例并发AS严重充血。此后，42例接受具有相当大的MHV分支的右肝移植物的成年受者接受了MHV引流重建。在供体肝切除术中保留所有直径大于5mm的MHV分支，并在台上手术中用受者自身的间置静脉移植物进行重建。这种改良右叶移植物的重建静脉移植物在移植物再血管化后与受者的MHV残端和/或左肝静脉吻合。
定期检查直至移植后30天的连续多普勒超声显示，42例受者中有38例（通畅率90.5%）间置静脉移植物通畅。在这38例受者中，增强计算机断层扫描未发现AS充血的证据，同时提供了与扩大右叶移植物相当的足够功能肝体积。这些受者也未观察到与充血相关的移植物损伤，如AS梗死。
我们的早期经验表明，在某些情况下没有MHV主干的右叶移植物需要进行MHV引流重建。然而，术前很难预测未进行MHV引流重建的右肝移植物的AS充血程度。我们建议在遇到相当大的MHV分支的情况下，积极重建AS的MHV引流分支，以预防可能的与充血相关的并发症。
