Kaneko J, Sugawara Y, Sato S, Kishi Y, Akamatsu N, Togashi J, Makuuchi M
Artificial Organ and Transplantation Division, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Transplant Proc. 2005 Jun;37(5):2166-8. doi: 10.1016/j.transproceed.2005.03.012.
Complete outflow is impossible to maintain on both sides in donors undergoing hemiliver graft harvesting, because the middle hepatic vein (MHV) can be preserved on only one side. The area in which outflow veins are disrupted becomes congested and does not sufficiently regenerate. The relation between changes in alanine aminotransferase (ALT) and the congestive area volume of the congestive area is unknown. The 64 subjects presented herein were living donors who provided the left liver with the caudate lobe and MHV trunk. The midpoint between the tributaries of the MHV and the right hepatic vein was determined preoperatively using computed tomography. The midpoint between the tributaries of the MHV and right hepatic vein and the borderline between the right and left liver were used to predict the MHV drainage area volume. ALT was measured in donors on postoperative days 1, 3, 5, 7, 10, and 14. The patients were divided into three groups according to the ratio of calculated MHV drainage area volume in the remnant right liver: less than 15% (n = 21, group A); greater than 15% and less than 20% (n = 18, group B); greater than 20% (n = 25, group C). There were significant differences in the ALT levels between groups (P = .004). MHV drainage area volume, calculated using the present method, was associated with high ALT levels after left liver harvesting with the MHV. The present study suggests that persistently high ALT levels are associated with the volume of the interrupted MHV drainage area.
在进行半肝移植供肝切取时，双侧完全保持流出道通畅是不可能的，因为肝中静脉（MHV）只能在一侧保留。流出静脉被破坏的区域会发生充血，且不能充分再生。丙氨酸转氨酶（ALT）变化与充血区域充血面积体积之间的关系尚不清楚。本文介绍的64名受试者均为活体供者，他们提供了带有尾状叶和MHV主干的左肝。术前使用计算机断层扫描确定MHV分支与右肝静脉之间的中点。MHV分支与右肝静脉之间的中点以及左右肝之间的边界线用于预测MHV引流区域体积。在术后第1、3、5、7、10和14天测量供者的ALT。根据剩余右肝中计算出的MHV引流区域体积比例，将患者分为三组：小于15%（n = 21，A组）；大于15%且小于20%（n = 18，B组）；大于20%（n = 25，C组）。各组之间的ALT水平存在显著差异（P = .004）。使用本方法计算的MHV引流区域体积与保留MHV的左肝切取术后的高ALT水平相关。本研究表明，持续的高ALT水平与中断的MHV引流区域体积有关。
