Moon Deok-Bog, Lee Sung-Gyu, Ahn ChulSoo, Hwang Shin, Kim Ki-Hun, Ha Taeyong, Song GiWon, Ryu JeHo, Sung KyuBo, Ko GiYoung
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Liver Transpl. 2007 Sep;13(9):1279-84. doi: 10.1002/lt.21252.
Adequate portal inflow is essential to the regeneration of a partial liver graft after adult living donor liver transplantation (LDLT). A recipient having large spontaneous portosystemic collaterals with or without portal vein (PV) stenosis would require surgical interruption of large collaterals and/or correction of PV stenosis to prevent postoperative "portal flow steal phenomenon." Intraoperative Doppler ultrasound (IOUS) has been used to estimate the adequacy of portal inflow, but it has a limitation to identify the correct anatomical and hemodynamic parameters of portosystemic collaterals. We initiated to utilize intraoperative cine-portogram (IOCP) to overcome the limitations of IOUS. The spontaneous portosystemic large collaterals in 5 of 156 adult LDLTs from March 2003 to February 2004 were precisely identified not by IOUS but by IOCP, and successfully interrupted. In addition, 3 of these patients had stenotic PV (<1 cm in diameter), which was interfering with the hepatopetal portal flow and the PVs were effectively widened by the placement of intraoperative PV stenting. In conclusion, IOCP seems to be an effective tool for precise detection of the persistent large portosystemic collaterals that were not detected by IOUS, and for monitoring their complete interruption.
足够的门静脉血流对成人活体肝移植（LDLT）后部分肝移植的再生至关重要。接受者若存在大量自发性门体分流，无论有无门静脉（PV）狭窄，都需要手术切断大的分流支和/或纠正PV狭窄，以防止术后“门静脉血流窃流现象”。术中多普勒超声（IOUS）已被用于评估门静脉血流是否充足，但它在识别门体分流的正确解剖和血流动力学参数方面存在局限性。我们开始利用术中动态门静脉造影（IOCP）来克服IOUS的局限性。在2003年3月至2004年2月期间的156例成人LDLT中，有5例的自发性门体大分流不是通过IOUS而是通过IOCP精确识别，并成功切断。此外，这些患者中有3例存在PV狭窄（直径<1 cm），这干扰了向肝门静脉血流，术中通过放置PV支架有效地扩张了PV。总之，IOCP似乎是一种有效的工具，可精确检测IOUS未发现的持续性大门体分流，并监测其完全切断情况。
