Ohdan Hideki, Mizunuma Kazuyuki, Tashiro Hirotaka, Tokita Daisuke, Hara Hidetaka, Onoe Takashi, Ishiyama Kohei, Shibata Satoshi, Mitsuta Hiroshi, Ochi Makoto, Nakahara Hideki, Itamoto Toshiyuki, Asahara Toshimasa
Department of Surgery, Division of Frontier Medical Science, Program for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Japan.
Transplantation. 2003 Sep 15;76(5):791-7. doi: 10.1097/01.TP.0000074603.36553.BD.
This study was performed to determine the usefulness of intraoperative near-infrared spectroscopy (NIRS) for evaluating the extent of congestion in the anterior segment of the graft after living-donor liver transplantation using right lobe grafts that do not have the middle hepatic vein.
Fifteen patients undergoing living-donor liver transplantation using a right lobe graft without the middle hepatic vein were enrolled in this study. During the course of harvesting and implantation, in vivo NIRS was performed on the liver grafts to determine hemoglobin (Hb) and cytochrome oxidase content in the hepatic tissues.
The 15 cases were divided into three groups according to the caliber of the middle hepatic vein tributaries in the right lobe grafts: the small group (<4 mm), the intermediate group (4-7 mm), and the large group (>7 mm). After implantation, congestion (increase in tissue Hb) in the anterior segment was more severe than that in the posterior segment in the intermediate and large groups. However, well-preserved mitochondrial cytochrome oxidase redox state was observed in both segments except for two cases in the large group with severe congestion in the anterior segment. The extent of postoperative congestion in the anterior segment was significantly correlated with the tissue content of remaining Hb in that segment after ex vivo flushing.
Intraoperative NIRS enables quantification of the extent of congestion in the anterior segment after implantation of a right lobe liver graft and even enables prediction of such congestion at the phase of ex vivo perfusion.
本研究旨在确定术中近红外光谱（NIRS）在评估使用无肝中静脉的右叶移植物进行活体肝移植后移植物前段充血程度方面的实用性。
15例接受使用无肝中静脉的右叶移植物进行活体肝移植的患者纳入本研究。在切取和植入过程中，对肝移植物进行活体NIRS检测，以测定肝组织中的血红蛋白（Hb）和细胞色素氧化酶含量。
根据右叶移植物中肝中静脉分支的管径，将15例患者分为三组：小分支组（<4mm）、中分支组（4 - 7mm）和大分支组（>7mm）。植入后，中分支组和大分支组前段的充血（组织Hb增加）比后段更严重。然而，除了大分支组中有两例前段严重充血的情况外，两段的线粒体细胞色素氧化酶氧化还原状态均保存良好。前段术后充血程度与体外冲洗后该段剩余Hb的组织含量显著相关。
术中NIRS能够量化右叶肝移植物植入后前段的充血程度，甚至能够在体外灌注阶段预测这种充血情况。
