Sugawara Yasuhiko, Makuuchi Masatoshi, Akamatsu Nobuhisa, Kishi Yoji, Niiya Takashi, Kaneko Junichi, Imamura Hiroshi, Kokudo Norihiro
Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Hongo, Tokyo, Japan.
Liver Transpl. 2004 Apr;10(4):541-7. doi: 10.1002/lt.20129.
Short and direct vein anastomosis is generally performed in living donor liver transplantation using a right liver graft. The graft will regenerate, however, and might thus compress the anastomosis. We formulated a strategy for outflow reconstruction in right liver graft. When reconstruction of multiple short hepatic veins was necessary, a cryopreserved inferior vena cava graft was anastomosed with the hepatic veins of the graft in a basin. When there were no major short hepatic veins in the graft, a rectangular-shaped vein graft was used to make a single orifice using the middle and right hepatic veins in the graft. When there were no tributaries of the middle hepatic vein to be reconstructed, a diamond-shaped vein patch was anastomosed on the anterior wall of the right hepatic vein orifice of the graft. These techniques were satisfactorily applied in 40 patients with no torsion or tension at the anastomotic site of the hepatic venous reconstruction or other complications in outflow. The present strategy seemed to be technically feasible for outflow reconstruction in a right liver graft.
在活体供肝肝移植中使用右肝移植物时，通常进行短而直接的静脉吻合。然而，移植物会再生，因此可能会压迫吻合口。我们制定了一种右肝移植物流出道重建策略。当需要重建多条短肝静脉时，将一段冷冻保存的下腔静脉移植物在一个区域内与移植物的肝静脉进行吻合。当移植物中没有主要的短肝静脉时，使用矩形静脉移植物利用移植物中的肝中静脉和肝右静脉形成一个单一的开口。当不需要重建肝中静脉的属支时，将菱形静脉补片吻合在移植物肝右静脉开口的前壁上。这些技术在40例患者中得到了满意的应用，肝静脉重建吻合部位没有扭转或张力，也没有流出道的其他并发症。目前的策略在技术上似乎对于右肝移植物的流出道重建是可行的。
