活体肝移植后肝脏移植物功能的最佳门静脉循环

Optimal portal venous circulation for liver graft function after living-donor liver transplantation.

作者信息

Yagi Shintaro, Iida Taku, Hori Tomohide, Taniguchi Kentaro, Yamamoto Chizuru, Yamagiwa Kentaro, Uemoto Shinji

机构信息

First Department of Surgery, Mie University School of Medicine, Tsu City, Japan.

出版信息

Transplantation. 2006 Feb 15;81(3):373-8. doi: 10.1097/01.tp.0000198122.15235.a7.

DOI:10.1097/01.tp.0000198122.15235.a7

PMID:16477223

Abstract

BACKGROUND

Previous studies have shown poor outcome after living-donor liver transplantation (LDLT) as a result of excessive portal venous pressure (PVP), excessive portal venous flow (PVF), or inadequate PVF. We investigated optimal portal venous circulation for liver graft function after LDLT in adult recipients retrospectively.

METHODS

Between June 2003 and November 2004, 28 adult patients underwent LDLT in our institution. We modulated PVP under 20 mmHg in these 28 cases by performing a splenectomy (n=4) or splenorenal shunt (n=1). The PVF and PVP were measured at the end of the operation. Compliance was calculated by dividing PVF by PVP.

RESULTS

PVF and compliance showed a significant inverse correlation with peak billirubin levels after LDLT (r = -0.63: r=-0.60, P<0.01), and with peak international normalized ratio after LDLT (r=-0.41: r=-0.51, P<0.05). Compliance was higher in right-lobe graft with middle hepatic vein cases (148+/-27 ml/min/mmHg), and lower in left-lobe graft cases (119+/-50 ml/min/mmHg).

CONCLUSIONS

Liver graft function was better when PVF and graft compliance were higher and PVP was maintained under 20 mmHg.

摘要

背景

既往研究表明，由于门静脉压力（PVP）过高、门静脉血流（PVF）过多或PVF不足，活体肝移植（LDLT）后的预后较差。我们回顾性研究了成人受体LDLT后肝移植功能的最佳门静脉循环。

方法

2003年6月至2004年11月，28例成年患者在我院接受了LDLT。我们通过脾切除术（n = 4）或脾肾分流术（n = 1）将这28例患者的PVP调节至20 mmHg以下。在手术结束时测量PVF和PVP。通过PVF除以PVP计算顺应性。

结果

PVF和顺应性与LDLT后的胆红素峰值水平呈显著负相关（r = -0.63：r = -0.60，P<0.01），与LDLT后的国际标准化比值峰值呈负相关（r = -0.41：r = -0.51，P<0.05）。伴有肝中静脉的右叶移植病例的顺应性较高（148±27 ml/min/mmHg），左叶移植病例的顺应性较低（119±50 ml/min/mmHg）。