Imura Satoru, Shimada Mitsuo, Miyake Kotaro, Ikemoto Tetsuya, Morine Yuji, Yoshizumi Tomoharu
Department of Surgery, University of Tokushima, Tokushima, Japan.
Hepatogastroenterology. 2008 Jul-Aug;55(85):1206-10.
BACKGROUND/AIMS: Left lobe graft is an ideal option to minimize potential risk for the donor in adult living-donor liver transplantation (LDLT). However, its use is restricted due to size limitations. The purpose of this study was to determine the impact of a new technique for the acquisition of additional liver volume for left lobe graft.
Three donors underwent left hepatic lobectomy by exploiting a new technique as follows: a demarcation line was marked by clamping the right first Glisson's pedicle. A parenchymal transection plane was located 1 cm right side from the demarcation line and just on the left side of the right anterior Glisson's pedicle. A part of the anterior segment added to the left lobe graft by this procedure belonged to right anterior segment by preoperative CT. The preoperative volumetry of the liver was performed using the 3D-CT software, which was able to calculate total liver volume and the volume of each vessel's territories. Additional liver volume was calculated by preoperative CT scan and defined as part of the perfusion area by the right anterior portal branch. Blood perfusion of the additional liver area was postoperatively assessed by dynamic CT, and graft outcome was also evaluated.
An additional gain ranged from 40 mL to 51 mL (mean 41.8 mL). GV/SLV was 35.7, 60.0, and 41.0%. The rate of additional volume in GV/SLV ranged from 7.2-8.4% (mean 7.6%). All grafts functioned well. The CT scan performed on early postoperative period confirmed excellent blood perfusion the additional segment. No complication attributable to small-for-size graft was noted.
This new technique for left lobe graft harvesting proved a promising approach to gain additional volume, thereby avoiding small-for-size graft in adult LDLT.
背景/目的：在成人活体肝移植（LDLT）中，左叶移植是将供体潜在风险降至最低的理想选择。然而，由于尺寸限制，其应用受到限制。本研究的目的是确定一种获取左叶移植额外肝体积的新技术的影响。
三名供体采用如下新技术进行左肝叶切除术：通过夹闭右侧第一肝门蒂标记一条分界线。实质横断平面位于分界线右侧1cm处且恰好在右前肝门蒂左侧。通过该操作添加到左叶移植的前段的一部分在术前CT上属于右前叶。使用3D-CT软件进行肝脏术前容积测量，该软件能够计算全肝体积和每个血管区域的体积。通过术前CT扫描计算额外肝体积，并将其定义为右前门静脉分支灌注区域的一部分。术后通过动态CT评估额外肝区域的血液灌注，并评估移植结果。
额外增加的体积范围为40mL至51mL（平均41.8mL）。移植肝体积/标准肝体积分别为35.7%、60.0%和41.0%。移植肝体积/标准肝体积中额外体积的比例范围为7.2 - 8.4%（平均7.6%）。所有移植肝功能良好。术后早期进行的CT扫描证实额外节段血液灌注良好。未发现与小体积移植相关的并发症。
这种获取左叶移植的新技术被证明是一种有前景的增加体积的方法，从而避免成人LDLT中的小体积移植。
