Kokudo Norihiro, Sugawara Yasuhiko, Imamura Hiroshi, Sano Keiji, Makuuchi Masatoshi
Department of Surgery, Hepato-Biliary-Pancreatic Surgery Division, University of Tokyo, Japan.
Transplantation. 2003 Sep 15;76(5):803-7. doi: 10.1097/01.TP.0000080982.03297.A7.
To control bleeding in the deeper parenchymal plane in right hepatectomy, Belghiti et al. (J Am Coll Surg 2001;193:109) proposed a liver-hanging maneuver using a sling passed between the anterior surface of the inferior vena cava (IVC) and the liver parenchyma. We applied this technique in donor operations in which a hepatic parenchymal transection should be performed before dividing the feeding or draining vessels for the graft.
After passing a tape between the liver and the IVC, the lower tip of the tape is pulled up behind the hepatic hilum to enable effective traction of the dorsal part of the liver. To preserve significant middle hepatic vein (MHV) tributaries in right-liver graft, the tape is gradually repositioned behind the veins, and parenchymal transection is completed before dividing the venous tributaries. Congestion of the graft is minimal until harvest. In right hepatectomy with the MHV, the tape is switched behind the MHV to preserve the MHV.
Since March 2000, this technique has been used in 71 consecutive donor operations, including 37 right hepatectomies without the MHV, 8 right hepatectomies with the MHV, 20 left hepatectomies with the caudate lobe, and 6 right lateral sectorectomies. Taping behind the liver was successful in all but one donor (98.6%). There were no major complications related to this procedure.
This new approach to the sling suspension of the liver with a gradual tape manipulation facilitated the suspending action and was useful in four types of donor operation. These techniques are feasible in most living donors and are recommended as basic procedures to enhance the safety of the donor and the quality of the graft.
为了控制右肝切除术中更深实质层面的出血，Belghiti等人（《美国外科医师学会杂志》2001年；193:109）提出了一种肝脏悬吊手法，即使用一条吊带从下腔静脉（IVC）前表面与肝实质之间穿过。我们在供体手术中应用了该技术，此类手术需在切断移植物的供血或引流血管之前进行肝实质横断。
在肝脏与IVC之间穿过一条带子后，将带子的下端向上拉至肝门后方，以便有效牵引肝脏的背侧部分。为了保留右肝移植物中重要的肝中静脉（MHV）分支，将带子逐渐重新放置在静脉后方，在切断静脉分支之前完成实质横断。直到获取移植物时，其充血情况一直保持在最低限度。在伴有MHV的右肝切除术中，将带子切换至MHV后方以保留MHV。
自2000年3月以来，该技术已连续应用于71例供体手术，包括37例不伴有MHV的右肝切除术、8例伴有MHV的右肝切除术、20例伴有尾状叶的左肝切除术以及6例右肝外侧段切除术。除1例供体（98.6%）外，肝脏后方的带子放置均成功。该手术未出现重大并发症。
这种通过逐渐操作带子来悬吊肝脏的新方法促进了悬吊作用，并且在四种类型的供体手术中均有用。这些技术在大多数活体供体中是可行的，推荐作为提高供体安全性和移植物质量的基本操作。
