Liu Chinsu, Loong Che-Chuan, Hsia Cheng-Yuan, Tsou Mei-Yung, Tsai Hsin-Lin, Wei Choufu
Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, Taiwan.
J Invest Surg. 2009 Nov-Dec;22(6):406-12. doi: 10.3109/08941930903410833.
Formal hepatic arterial flush to preserve the liver graft in living donor liver transplantation (LDLT) is not recommended by most transplant centers because direct cannulation may injure the intima of the hepatic artery. The authors describe a method of retrograde arterial flush of the liver graft without arterial cannulation by hepatic venous outflow occlusion (HVOO) in LDLT. First, we proved no backflow of the hepatic artery without HVOO by portal flush to pig livers. Then we used HVOO on 15 LDLT cases (Group HVOO). The results were compared with those of 24 counterpart LDLT cases (Group non-HVOO) without hepatic artery flush. The two-week posttransplantational liver functions were not different between two groups except that the day-three and day-seven serum bilirubin levels were lower in Group HVOO (day-three total bilirubin: 4.99 +/- 4.04 mg/dl versus 7.65 +/- 4.33 mg/dl, p =.016; day-seven total bilirubin: 5.06 +/- 5.02 mg/dl versus 9.57 +/- 6.09, p =.005). The rates of vascular complications, six-month graft survival, and biliary anastomotic stricture in Group HVOO were 0, 93.3, and 13.3% respectively, which were not different from those of Group non-HVOO. In summary, to avoid intima injury, the retrograde arterial flush of liver graft by HVOO is safe in LDLT. The short-term results showed the effect of decreasing early functional cholestasis but the long-term benefits need further evaluation, especially with regards to biliary anastomotic complications.
大多数移植中心不建议在活体肝移植（LDLT）中进行正式的肝动脉冲洗以保护肝移植，因为直接插管可能会损伤肝动脉内膜。作者描述了一种在LDLT中通过肝静脉流出道阻断（HVOO）进行肝移植逆行动脉冲洗而无需动脉插管的方法。首先，我们通过对猪肝进行门静脉冲洗证明了在没有HVOO的情况下肝动脉没有逆流。然后我们对15例LDLT病例（HVOO组）使用了HVOO。将结果与24例未进行肝动脉冲洗的对照LDLT病例（非HVOO组）的结果进行比较。两组移植后两周的肝功能没有差异，只是HVOO组第三天和第七天的血清胆红素水平较低（第三天总胆红素：4.99±4.04mg/dl对7.65±4.33mg/dl，p = 0.016；第七天总胆红素：5.06±5.02mg/dl对9.57±6.09，p = 0.005）。HVOO组的血管并发症发生率、六个月移植存活率和胆肠吻合口狭窄率分别为0、93.3%和13.3%，与非HVOO组没有差异。总之，为避免内膜损伤，在LDLT中通过HVOO进行肝移植逆行动脉冲洗是安全的。短期结果显示有减少早期功能性胆汁淤积的作用，但长期益处需要进一步评估，特别是关于胆肠吻合口并发症方面。
