Wu Jian, Wang Weilin, Zhang Min, Shen Yan, Liang Tingbo, Yu Pengfei, Xu Xiao, Yan Sheng, Zheng Shusen
Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Transpl Int. 2008 Sep;21(9):843-9. doi: 10.1111/j.1432-2277.2008.00690.x. Epub 2008 May 13.
Although a right liver graft without the middle hepatic vein (MHV) can cause congestion in the anterior segment, the reconstruction of MHV tributaries and the complex procedure remain controversial. Between November 2006 and October 2007, right liver transplantation without the MHV was performed in 31 cases. A retrospective analysis was conducted on clinical data and two groups were formed: with MHV reconstruction (Group I, n=16) and without MHV reconstruction (Group II, n=15). We analyzed the serum liver function markers at 3 weeks postoperatively and evaluated vascular flow in the graft and interpositional vein daily by Doppler ultrasonography during the hospital stay and monthly follow-up after discharge. One patient (6.7%) died of liver congestion and acute hepatic rejection on the postoperative day 10 in Group II. Congestion was observed in another three cases (20%) of Group II and one case (6.25%) of Group I. The levels of alanine transferase and aspartate transferase in Group II was higher than those in Group I in the first week after transplantation, albeit not significantly. In Group I, most of the interpositional vein grafts were the recipient's portal veins. Venoplasty in the graft was performed in three cases. All the interpositional veins and tectonic outflow orifices were detected to be patent by ultrasonography within 14 days after transplantation. The reconstruction of the MHV tributaries is necessary in the right liver graft without MHV according to our policy and better criteria for MHV reconstruction should be established. The recipient's portal vein is an optimal choice for the interpositional vein and hepatic venoplasty in living donor liver transplantation can simplify the operation and ensure excellent venous drainage.
尽管没有肝中静脉（MHV）的右肝移植可能会导致肝前段淤血，但MHV分支的重建及复杂手术仍存在争议。2006年11月至2007年10月，对31例未进行MHV重建的右肝移植病例进行了回顾性分析。根据是否进行MHV重建将患者分为两组：进行MHV重建的患者为I组（n = 16），未进行MHV重建的患者为II组（n = 15）。我们分析了术后3周时的血清肝功能指标，并在住院期间通过多普勒超声每日评估移植肝和搭桥静脉的血流情况，出院后每月进行随访。II组中有1例患者（6.7%）在术后第10天死于肝淤血和急性肝排斥反应。II组中另有3例患者（20%）出现了淤血，I组中有1例患者（6.25%）出现了淤血。移植后第一周，II组的丙氨酸转氨酶和天冬氨酸转氨酶水平高于I组，尽管差异不显著。在I组中，大多数搭桥静脉取自受者的门静脉。有3例患者进行了移植肝静脉成形术。移植后14天内通过超声检查发现所有搭桥静脉和构造性流出道均通畅。根据我们的经验，对于没有MHV的右肝移植，重建MHV分支是必要的，并且应该建立更好的MHV重建标准。在活体肝移植中，受者的门静脉是搭桥静脉的最佳选择，肝静脉成形术可以简化手术并确保良好的静脉引流。
