Concejero Allan, Chen Chao-Long, Wang Chih-Chi, Wang Shih-Ho, Lin Chih-Che, Liu Yeuh-Wei, Yang Chin-Hsiang, Yong Chee-Chien, Lin Tsan-Shiun, Ibrahim Salleh, Jawan Bruno, Cheng Yu-Fan, Huang Tung-Liang
Department of Surgery, Liver Transplantation Program, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Niao-Sung, Kaohsiung, Taiwan.
Liver Transpl. 2006 Feb;12(2):264-8. doi: 10.1002/lt.20699.
Hepatic venous outflow reconstruction is a key to successful living donor liver transplantation (LDLT) because its obstruction leads to graft dysfunction and eventual loss. Inclusion or reconstruction of most draining veins is ideal to ensure graft venous drainage and avoids acute congestion in the donor graft. We developed donor graft hepatic venoplasty techniques for multiple hepatic veins that can be used in either right- or left-lobe liver transplantation. In left-lobe grafts, venoplasty consisting of the left hepatic vein and adjacent veins such as the left superior vein, middle hepatic vein, or segment 3 vein is performed to create a single, wide orifice without compromising outflow for anastomosis with the recipient's vena cava. In right lobe graft where a right hepatic vein (RHV) is adjacent with a significantly-sized segment 8 vein, accessory RHV, and/or inferior RHV, venoplasty of the RHV with the accessory RHV, inferior RHV, and/or segment 8 vein is performed to create a single orifice for single outflow reconstruction with the recipient's RHV or vena cava. Of 35 venoplasties, 2 developed hepatic venous stenoses which were promptly managed with percutaneous interventional radiologic procedures. No graft was lost due to hepatic venous stenosis. In conclusion, these techniques avoid interposition grafts, are easily performed at the back table, simplify graft-to-recipient cava anastomosis, and avoid venous outflow narrowing.
肝静脉流出道重建是活体肝移植（LDLT）成功的关键，因为其梗阻会导致移植物功能障碍并最终丧失。纳入或重建大多数引流静脉对于确保移植物静脉引流并避免供体移植物急性充血是理想的。我们开发了用于多条肝静脉的供体移植物肝静脉成形术技术，可用于右叶或左叶肝移植。在左叶移植物中，对由左肝静脉和相邻静脉（如左肝上静脉、肝中静脉或3段静脉）组成的静脉进行成形术，以创建一个单一的、宽阔的开口，而不影响与受体腔静脉吻合的流出道。在右叶移植物中，当右肝静脉（RHV）与明显大小的8段静脉、副RHV和/或肝右下静脉相邻时，对RHV与副RHV、肝右下静脉和/或8段静脉进行静脉成形术，以创建一个单一开口，用于与受体的RHV或腔静脉进行单一流出道重建。在35例静脉成形术中，有2例出现肝静脉狭窄，通过经皮介入放射学程序迅速得到处理。没有移植物因肝静脉狭窄而丢失。总之，这些技术避免了中间移植物，易于在手术台后部进行，简化了移植物与受体腔静脉的吻合，并避免了静脉流出道变窄。
