de Villa Vanessa H, Chen Chao-Long, Chen Yaw-Sen, Wang Chih-Chi, Lin Chih-Che, Cheng Yu-Fan, Huang Tung-Liang, Jawan Bruno, Eng Hock-Liew
Department of Surgery, Chang Gung University, Kaohsiung, Taiwan.
Ann Surg. 2003 Aug;238(2):275-82. doi: 10.1097/01.SLA.0000081093.73347.28.
To describe our approach in the decision-making for taking the middle hepatic vein with the graft or leaving it with the remnant liver in right lobe live donor liver transplantation.
Right lobe living donor liver transplantation has been successfully performed. However, the extent of donor hepatectomy is still a subject of debate and the main considerations in the decision making are graft functional adequacy and donor safety.
An algorithm based on donor-recipient body weight ratio, right lobe-to-recipient standard liver volume estimate, and donor hepatic venous anatomy was used to decide the extent of donor hepatectomy. This algorithm was applied in 25 living donor liver transplant operations performed between January 1999 and January 2002. In grafts taken without the middle hepatic vein, anterior segment tributaries draining into it were not reconstructed. Outcomes between right lobe liver transplants with (Group I) and without (Group II) the middle hepatic vein were compared.
Ten grafts included the middle hepatic vein and 15 did not. The mean graft to recipient standard liver volume ratio was 58% and 64% in Groups I and II, respectively, and the difference was not statistically significant. Donors from both groups had comparable recovery, with 2 complications, 1 from each group, requiring a percutaneous drainage procedure. The recipient outcomes were, likewise, comparable and there was 1 case of structural outflow obstruction in Group I, which required venoangioplasty and stenting. There were 2 recipient mortalities, 1 due to a biliary complication and the other to recurrent hepatitis C. Another patient required retransplantation for secondary biliary cirrhosis. The overall actuarial graft and patient survival rates are 84% and 96%, respectively, at a median follow-up of 16 months.
Based on certain preoperative criteria, a right lobe graft can be taken with or without the middle hepatic vein with equally successful outcomes in both the donors and recipients. The decision, therefore, of the extent of right lobe donor hepatectomy should be tailored to the particular conditions of each case.
描述我们在右半肝活体供肝移植中决定是将肝中静脉随移植物一并切取还是保留在残余肝脏中的决策方法。
右半肝活体供肝移植已成功实施。然而，供肝切除范围仍是一个有争议的问题，决策时的主要考虑因素是移植物功能的充分性和供体安全性。
采用一种基于供受体体重比、右半肝与受体标准肝体积估计以及供体肝静脉解剖结构的算法来决定供肝切除范围。该算法应用于1999年1月至2002年1月期间进行的25例活体供肝移植手术。在未切取肝中静脉的移植物中，未重建汇入肝中静脉的前段分支。比较了保留肝中静脉的右半肝移植（I组）和未保留肝中静脉的右半肝移植（II组）的结果。
10例移植物包含肝中静脉，15例不包含。I组和II组移植物与受体标准肝体积的平均比值分别为58%和64%，差异无统计学意义。两组供体的恢复情况相当，各有2例并发症，每组1例，均需经皮引流处理。受体的结果同样相当，I组有1例发生结构性流出道梗阻，需行血管成形术和支架置入术。有2例受体死亡，1例死于胆道并发症，另1例死于丙型肝炎复发。另1例患者因继发性胆汁性肝硬化需要再次移植。在中位随访16个月时，总体移植肝和患者的 actuarial 生存率分别为84%和96%。
根据某些术前标准，右半肝移植物可以切取或不切取肝中静脉，供体和受体的结果同样成功。因此，右半肝供肝切除范围的决策应根据每个病例的具体情况进行调整。
