Kanazawa Akishige, Hirohashi Kazuhiro, Tanaka Hiromu, Kubo Shoji, Yamamoto Takatugu, Hai Seikan, Kinoshita Hiroaki, Nishida Norifumi, Tanaka Koichi
Department of Gastroenterological and Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Liver Transpl. 2002 Nov;8(11):1076-9. doi: 10.1053/jlts.2002.35547.
Although living-donor liver transplantation (LDLT) of right lobe graft is becoming a popular option for adult patients, management of venous outflow remains controversial. We report a successful extended-right lobe liver transplantation using a recipient's left portal vein as a graft from the middle hepatic vein. Preoperative three-dimensional computed tomography (3D-CT) of the donor revealed a small right hepatic vein (RHV) without inferior RHV and a large middle hepatic vein (MHV) draining segments 5 and 8. During the donor operation, right lobe graft was harvested with the MHV, preserving the drainage vein from segment 4. The donor recovered uneventfully except for mild transient hyperbilirubinemia. The recipient's condition rapidly improved, and was discharged from hospital 49 days postoperation. A 3D-CT after LDLT also clearly revealed successful vascular anastomosis. Preoperative and postoperative 3D-CT was useful for determination of the vascular anatomy and the decision about the line of transection in the donor hepatectomy, as well as for evaluation of the vascular anastomoses after transplantation.
尽管右叶移植物活体肝移植（LDLT）正成为成年患者的一种常用选择，但静脉流出道的管理仍存在争议。我们报告了一例成功的扩大右叶肝移植，使用受者的左门静脉作为来自肝中静脉的移植物。供者术前三维计算机断层扫描（3D-CT）显示右肝静脉（RHV）细小且无肝右下静脉，肝中静脉（MHV）粗大，引流第5和第8段。在供者手术过程中，切取带有MHV的右叶移植物，保留来自第4段的引流静脉。供者除轻度短暂性高胆红素血症外恢复顺利。受者病情迅速改善，术后49天出院。LDLT术后的3D-CT也清楚显示血管吻合成功。术前和术后的3D-CT有助于确定血管解剖结构、决定供肝切除术的切断线，以及评估移植后的血管吻合情况。
