Wu Hong, Yang Jia-yin, Yan Lü-nan, Li Bo, Zeng Yong, Wen Tian-fu, Zhao Ji-chun, Wang Wen-Tao, Xu Ming-Qing, Lu Qiang, Chen Zhe-Yu, Ma Yu-Kui, Li Jin
Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, China.
Chin Med J (Engl). 2007 Jun 5;120(11):947-51.
It is difficult and challenging to reconstruct hepatic venous outflow in adult right lobe living donor liver transplantation (LDLT) without the middle hepatic vein (MHV). Excessive perfusion of the portal vein and venous outflow obstruction will lead to acute congestion of the graft, ultimately resulting in primary nonfunction. Although various reconstruction patterns have been explored in many countries, there is currently no clear consensus. In this study we describe a technique to prevent "chocking" of the graft at the outflow anastomosis with the inferior vena cava (IVC) in LDLT using right lobe graft without the MHV.
A retrospective analysis was conducted on clinical data from 55 recipients undergoing LDLT using right lobe grafts without the MHV or reconstruction of hepatic venous outflow. The donor's right hepatic vein (RHV) was anastomosed with a triangular opening of the recipient IVC; the inferior right hepatic vein (IRHV), if large enough, was anastomosed directly to the IVC. The great saphenous vein (GSV) was used for reconstruction of significant MHV tributaries.
No deaths occurred in any of the donors. Of the 55 recipients, complications occurred in 6, including hepatic vein stricture (1 case), small-for-size syndrome (1), hepatic artery thrombosis (1), intestinal bleeding (1), bile leakage (1), left subphrenic abscess and pulmonary infection (1). A total of three patients died, one from small-for-size syndrome and two from multiple system organ failure.
The multiple-opening vertical anastomosis was reconstructed with hepatic vein outflow. This technique alleviates surgical risk of living donors, ensures excellent venous drainage, and prevents vascular thromboses and primary nonfunction.
在无肝中静脉（MHV）的成人右叶活体肝移植（LDLT）中，重建肝静脉流出道既困难又具有挑战性。门静脉过度灌注和静脉流出道梗阻会导致移植物急性充血，最终导致原发性无功能。尽管许多国家已经探索了各种重建模式，但目前尚无明确的共识。在本研究中，我们描述了一种技术，用于在使用无MHV的右叶移植物进行LDLT时，防止移植物在与下腔静脉（IVC）的流出道吻合处出现“堵塞”。
对55例接受无MHV右叶移植物或肝静脉流出道重建的LDLT受者的临床资料进行回顾性分析。将供体的右肝静脉（RHV）与受者IVC的三角形开口进行吻合；右下肝静脉（IRHV）如果足够大，则直接与IVC吻合。大隐静脉（GSV）用于重建重要的MHV分支。
所有供体均未死亡。55例受者中，6例出现并发症，包括肝静脉狭窄（1例）、小肝综合征（1例）、肝动脉血栓形成（1例）、肠道出血（1例）、胆漏（1例）、左膈下脓肿和肺部感染（1例）。共有3例患者死亡，1例死于小肝综合征，2例死于多系统器官衰竭。
采用多开口垂直吻合重建肝静脉流出道。该技术降低了活体供体的手术风险，确保了良好的静脉引流，并预防了血管血栓形成和原发性无功能。
