Kilic Murat, Aydin Unal, Sozbilen Murat, Ozer Ilter, Tamsel Sadik, Demirpolat Gulgun, Atay Yuksel, Alper Mehmet, Zeytunlu Murat
Ege University School of Medicine Organ Transplantation and Research Center, Izmir, Turkey.
Transpl Int. 2007 Aug;20(8):697-701. doi: 10.1111/j.1432-2277.2007.00499.x. Epub 2007 May 19.
Congestion of the anterior sector may lead to graft failure in right lobe grafts. Selective drainage of the prominent segment 5 and/or 8 veins is proposed to overcome this problem. Different vascular conduits may be used during drainage of the anterior sector. In this study, we evaluated the efficiency of the vascular conduits. Between June 1999 and December 2005, 190 patients underwent living donor right lobe liver transplantation and reconstruction of segment 5 and/or 8 veins was performed in 48 patients (25.2%). Two groups were formed according to the types of vascular conduits. Cryopreserved cadaveric iliac artery (n = 28) and cryopreserved cadaveric iliac vein (n = 8) were used in group A. In group B, recipient saphenous vein (n = 6), recipient umbilical vein (n = 5) and recipient collateral omental vein (n = 1) were used for reconstruction. The graft-recipient weight ratio, mean duration of anhepatic phase and MELD scores between two groups were not significantly different. All of the conduits were found to be patent just after reperfusion and in the early postoperative period by Doppler ultrasonography. In follow-up period of 1 year, four (11%) patients died in group A, two patients (16%) in group B. One of these patients died because of sepsis started from the saphenous vein incision site. None of the patients dying in the two groups were lost due to venous outflow problems. This study proves the efficacy of drainage of segment 5 and/or 8 veins using cryopreserved cadaveric vascular conduits. Every effort should be employed to store cadaveric iliac vessels, otherwise, whole other additive surgical intervention to ensure vascular conduit may lead uninvited serious complication.
右叶移植中前叶充血可能导致移植失败。建议对显著的5段和/或8段静脉进行选择性引流以解决此问题。在前叶引流过程中可使用不同的血管导管。在本研究中，我们评估了血管导管的有效性。1999年6月至2005年12月期间，190例患者接受了活体供肝右叶移植，其中48例患者（25.2%）进行了5段和/或8段静脉重建。根据血管导管类型分为两组。A组使用冷冻保存的尸体髂动脉（n = 28）和冷冻保存的尸体髂静脉（n = 8）。B组使用受体大隐静脉（n = 6）、受体脐静脉（n = 5）和受体网膜侧支静脉（n = 1）进行重建。两组之间的移植物与受体重量比、无肝期平均持续时间和终末期肝病模型（MELD）评分无显著差异。通过多普勒超声检查发现，所有导管在再灌注后及术后早期均通畅。在1年的随访期内，A组有4例（11%）患者死亡，B组有2例（16%）患者死亡。其中1例患者因大隐静脉切口部位发生败血症死亡。两组中死亡的患者均未因静脉流出问题而丢失。本研究证明了使用冷冻保存的尸体血管导管对5段和/或8段静脉进行引流的有效性。应尽一切努力保存尸体髂血管，否则，为确保血管导管而进行的其他额外手术干预可能会导致意想不到的严重并发症。
