Chen Tai-Yi, Chen Chao-Long, Huang Tung-Liang, Tsang Leo Leung-Chit, Wang Chih-Chi, Wang Shih-Ho, Yang Chin-Hsiang, Concejero Allan M, Cheng Yu-Fan
Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Clin Transplant. 2006 Nov-Dec;20(6):725-31. doi: 10.1111/j.1399-0012.2006.00554.x.
Graft harvest with or without the middle hepatic vein (MHV) affects venous return and function of the remaining liver. The aims of this study are to compare the remnant liver volume and spleen changes in the donors of different types of graft harvest and to evaluate the influence of resection with or without the MHV on the remnant liver volume regeneration, spleen volume change and serum total bilirubin.
A total of 165 donors were grouped according to the type of graft harvest: 88 donors underwent left lateral segmentectomy (LLS), 10 donors underwent extend LLS or left lobectomy (LL), and 67 donors underwent right lobectomy (RL). Groups LLS and LL were later combined as group LH (left hepatectomy, n = 98). There were 68 men and 97 women. The mean age was 32.9 +/- 8.1 yr. The total liver volume (LV) and spleen volume (S1) before graft harvest, graft weight (GW), regenerated liver volume (LV(6m)) and spleen volume (S2) six months post-donation were calculated.
There were no significant differences in the regenerated liver volume six months postoperation (LV(6m)) and recovery ratio (LV(6m)/LV x 100%) among the different groups, albeit significant smaller LV(6m) in both groups compared with the initial liver volume was noted. Postoperative spleen volume (S2), average spleen ratio (S2/S1) and spleen change ratio were significantly larger and higher in group RL than in group LH. A significant increase in spleen volume was noted in both groups six months after graft harvest. A significantly higher TB in group RL (4.1 +/- 1.7 mg/dL, range: 1.4-8.5 mg/dL) was noted compared with that of group LH (1.6 +/- 1.0 mg/dL, range: 0.7-6.2 mg/dL).
There was a significant increase in the regenerated remnant liver and splenic volumes six months postoperation in all types of hepatectomy following living donor hepatectomy, and there was no difference in the mean TB levels among donors whether the MHV was included or not in the graft.
保留或不保留肝中静脉（MHV）进行肝移植供肝切取会影响剩余肝脏的静脉回流及功能。本研究旨在比较不同类型供肝切取方式下供体的残余肝体积和脾脏变化，并评估保留或不保留MHV的肝切除对残余肝体积再生、脾脏体积变化及血清总胆红素的影响。
165例供体根据供肝切取类型分组：88例行左外叶切除术（LLS），10例行扩大左外叶切除术或左半肝切除术（LL），67例行右半肝切除术（RL）。LLS组和LL组合并为LH组（左肝切除术，n = 98）。其中男性68例，女性97例。平均年龄为32.9±8.1岁。计算供肝切取前的全肝体积（LV）和脾脏体积（S1）、移植肝重量（GW）、术后6个月的再生肝体积（LV(6m)）和脾脏体积（S2）。
不同组术后6个月的再生肝体积（LV(6m)）及恢复率（LV(6m)/LV×100%）无显著差异，尽管两组的LV(6m)均显著小于初始肝体积。RL组术后脾脏体积（S2）、平均脾脏比率（S2/S1）及脾脏变化率均显著大于LH组且更高。供肝切取后6个月两组脾脏体积均显著增加。RL组的总胆红素（TB）显著高于LH组（4.1±1.7mg/dL，范围：1.4 - 8.5mg/dL），LH组为（1.6±1.0mg/dL，范围：0.7 - 6.2mg/dL）。
活体肝移植术后所有类型肝切除术后6个月残余再生肝体积和脾脏体积均显著增加，供体中无论移植肝是否包含MHV，平均TB水平均无差异。
