Department of General Surgery, Fourth Affiliated Hospital, Guangxi Medical University, Liuzhou, China.
Liver Transpl. 2010 Nov;16(11):1236-41. doi: 10.1002/lt.22138.
The aim of this study was to investigate the differences in portal hemodynamics between whole liver transplantation and living donor liver transplantation (LDLT). Twenty patients who underwent LDLT (the L group) and 42 patients who underwent whole liver transplantation (the W group) were enrolled, and colored Doppler ultrasonography was performed preoperatively and on postoperative days (PODs) 1, 3, 5, 7, 30, and 90. The changes in the portal blood flow velocity (PBV) and portal blood flow volume (PBF) were monitored. The graft and spleen sizes were measured with angiographic computed tomography, and upper endoscopy was used to measure esophageal varices on PODs 14, 30, and 90. Although the portal venous pressure (PVP) decreased after graft implantation, it was higher in the L group with a smaller graft size ratio (25.7 ± 5.1 cm H₂O for the L group and 18.5 ± 4.6 cm H₂O for the W group, P < 0.05). PBF and PBV increased in both the W and L groups on POD 1 after transplantation; however, the PBF and PBV peaks were significantly higher in the W group. The postoperative PVP and graft volume were greatly related to PBF on POD 1. Grafts in the L group regenerated rapidly after the operation, and the volume increased from 704 ± 115 to 1524 ± 281 mL as early as 1 month after transplantation. A rapid improvement in splenomegaly was observed in both groups. An improvement in esophageal varices was observed in the W group on POD 14 after transplantation, whereas no change was observed in the L group. The portal venous flow in patients with portal hypertension showed a high perfusion state after LDLT, but in contrast to whole liver transplantation, the PVP elevation after LDLT postponed the closing time of the collateral circulation and affected the recovery from splenomegaly.
本研究旨在探讨全肝移植与活体肝移植（LDLT）之间肝门脉血液动力学的差异。共纳入 20 例行 LDLT 的患者（L 组）和 42 例行全肝移植的患者（W 组），分别于术前和术后第 1、3、5、7、30 和 90 天行彩色多普勒超声检查，监测门静脉血流速度（PBV）和门静脉血流量（PBF）的变化。采用血管造影 CT 测量供体和脾脏大小，上消化道内镜测量术后第 14、30 和 90 天的食管静脉曲张情况。尽管在供体植入后门静脉压力（PVP）下降，但供体体积较小的 L 组的 PVP 更高（L 组为 25.7±5.1cmH₂O，W 组为 18.5±4.6cmH₂O，P<0.05）。移植后第 1 天，W 组和 L 组的 PBF 和 PBV 均增加，但 W 组的 PBV 和 PBF 峰值明显更高。术后第 1 天的 PVP 和供体体积与 PBF 有很大关系。L 组术后供体快速再生，1 个月后体积从 704±115 增加到 1524±281mL。两组脾肿大均迅速改善。W 组术后第 14 天食管静脉曲张改善，而 L 组无变化。门脉高压患者的门静脉血流在 LDLT 后表现出高灌注状态，但与全肝移植不同，LDLT 后 PVP 升高会推迟侧支循环的关闭时间，影响脾肿大的恢复。
