Moon I S, Kim D G, Lee M D, Hong S K, Park S C, Oh D Y, Ahn S T, Lee Y J
Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Transplant Proc. 2005 Mar;37(2):1117-8. doi: 10.1016/j.transproceed.2004.11.040.
Right anterior-medial lobe congestion due to temporary clamping of segment V and/or VIII is common in the operative theater during adult donor right lobe liver transplantation, the most common procedure in our institute. We have used an autogenous saphenous vein conduit to recipient portal vein tributaries in 15 cases, as a "Y-to-I venoplasty" since January 2004. The recipient portal vein is transected 5 mm proximal to its bifurcation and extended to both sides with partial hepatic dissection. The "Y-to-I venoplasty" is made by suture closure of the portal vein transversely to form a tube. The average length is 7.5 cm with a 1.3 cm width. One end of "Y-to-I venoplasty" conduit is anastomosed to the donor segment V branch on the back table. And the other end is anastomosed directly to the IVC via a new window or the middle hepatic vein stump in recipient. The phase distension of the conduit with respiration is noted in the operative field. A 6/15 (40%) patency rate, was observed by CT angiography at the second postoperative week. All-patient conduits showed good flow on serial examinations at the 60th postoperative day. This new venous graft, made of recipient portal vein is a good conduit for segment V decongestion in adult right lobe partial liver transplantation.
在成人供体右叶肝移植手术过程中，我院最常见的手术方式，由于暂时夹闭Ⅴ段和/或Ⅷ段导致右前内侧叶充血很常见。自2004年1月以来，我们在15例患者中使用自体大隐静脉导管连接受体门静脉分支，即“Y形到I形静脉成形术”。在门静脉分叉近端5mm处横断受体门静脉，并通过部分肝游离向两侧延伸。“Y形到I形静脉成形术”是通过横向缝合门静脉形成一个管道。平均长度为7.5cm，宽度为1.3cm。“Y形到I形静脉成形术”导管的一端在手术台上与供体Ⅴ段分支吻合。另一端通过新窗口或受体的肝中静脉残端直接与下腔静脉吻合。在手术视野中可观察到导管随呼吸的阶段性扩张。术后第二周通过CT血管造影观察到通畅率为6/15（40%）。在术后第60天的系列检查中，所有患者的导管均显示血流良好。这种由受体门静脉制成的新型静脉移植物是成人右叶部分肝移植中Ⅴ段充血的良好导管。
