Shin Ji Hoon, Sung Kyu-Bo, Yoon Hyun-Ki, Ko Gi-Young, Kim Kyoung Won, Lee Sung-Gyu, Hwang Shin, Ahn Chul-Soo, Kim Ki-Hun, Moon Deok-Bog, Song Ho-Young, Ha Tae-Yong
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea.
Liver Transpl. 2006 Feb;12(2):269-76. doi: 10.1002/lt.20590.
Middle hepatic vein (MHV) reconstruction is performed to drain the right paramedian sector to prevent hepatic venous congestion (HVC). The aim of the present study was to evaluate endovascular stent placement in patients with stenosed and/or occluded interposition vein graft (IVG) to segment V hepatic vein (V5) and segment VIII hepatic vein (V8) after living-donor liver transplantation (LDLT). The procedure was performed in 11 recipients; 7 underwent it within 24 hours of LDLT. The following parameters, including technical success, clinical success, complications, patient survival data, and serial computed tomography (CT) findings during follow-up, were documented retrospectively. Technical success was defined as both successful stent placement and resolution of stenosis or occlusion with copious flow of contrast medium through the stent, while clinical success was defined as both improvement of liver function tests (LFTs) and reduction or disappearance of hepatic low-attenuation areas on follow-up CT scans taken within 1 week of stent placement. Technical success was achieved in 10 of 11 patients (91%), and clinical success was achieved in 9 of 11 patients (82%). Acute thrombotic occlusion of the stent-inserted hepatic vein occurred in 1 patient 1 day following stent placement. During the mean follow-up period of 468 days (range, 13-891 days), 9 patients survived and 2 patients died. No death was directly related to stent placement or its related complications. The low-attenuation area in the involved hepatic segment V (S5) and/or VIII (S8) area prior to stent placement disappeared completely on follow-up CT scans performed at 3-12 days (mean, 5.4 days) after stent placement in all 9 patients with clinical success. No attenuation change occurred even in cases with chronic occlusion of the stent-inserted hepatic veins. In conclusion, though IVG to V5 and V8 remains controversial, the treatment of their stenosis or occlusion is safe and effective, even during their immediate postoperative period.
进行肝中静脉（MHV）重建以引流右旁正中肝段，防止肝静脉淤血（HVC）。本研究的目的是评估在活体肝移植（LDLT）后，对肝段V肝静脉（V5）和肝段VIII肝静脉（V8）的狭窄和/或闭塞的间置静脉移植物（IVG）患者进行血管内支架置入术的效果。该手术在11例受者中进行；7例在LDLT后24小时内接受了该手术。回顾性记录了以下参数，包括技术成功率、临床成功率、并发症、患者生存数据以及随访期间的系列计算机断层扫描（CT）结果。技术成功定义为支架置入成功且狭窄或闭塞解除，造影剂通过支架大量流动；而临床成功定义为肝功能检查（LFTs）改善以及在支架置入后1周内进行的随访CT扫描中肝脏低密度区减少或消失。11例患者中有10例（91%）获得技术成功，11例患者中有9例（82%）获得临床成功。1例患者在支架置入后1天发生了支架置入肝静脉的急性血栓闭塞。在平均468天（范围13 - 891天）的随访期内，9例患者存活，2例患者死亡。没有死亡与支架置入或其相关并发症直接相关。在所有9例获得临床成功的患者中，支架置入前受累肝段V（S5）和/或VIII（S8）区域的低密度区在支架置入后3 - 12天（平均5.4天）进行的随访CT扫描中完全消失。即使在支架置入肝静脉慢性闭塞的情况下也未发生衰减变化。总之，尽管V5和V8的IVG仍存在争议，但对其狭窄或闭塞的治疗即使在术后即刻也是安全有效的。
