Guan Zhaojie, Ren Xiuyun, Xu Guangxun, Zang Yunjin, Chen Xinguo, Shen Zhongyang
Institute of Transplantation, General Hospital of People's Armed Force Police, Beijing 100039, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Nov;25(11):1393-6.
To summarize the experience of living donor liver transplantation using cryopreserved iliac vein for middle hepatic vein reconstruction.
Between July 2006 and June 2009, right liver transplantation without middle hepatic vein was performed in 37 cases of 85 patients undergoing living donor liver transplantation; of 37 cases, 30 received middle hepatic vein reconstruction using cryopreserved iliac vein. There were 27 males and 3 females, aged from 10 to 57 years (median, 44 years). Thirty cases included 11 hepatocellular carcinoma, 10 hepatic cirrhosis, 2 Wilson's disease, 1 cholangiocarcinoma, 1 hepatoblastoma, 1 congenital hepatic fibrosis, 1 chronic severe hepatitis, and 1 congenital biliary atresia. Iliac veins harvested from donors were put into 0-4 degrees C mixed antibiotics saline and transported to the operating room. The iliac veins were trimmed, placed into sterile bags (containing RMPI 1640 + 20% DMSO + 10% calf protein solution) and frozen at -70 degrees C. In living donor liver transplantation process, the veins were melt and used for middle hepatic vein reconstruction. After operation, the patency of veins was monitored by regular Doppler ultrasound examination or enhanced CT for 3 months.
In 30 patients, 30 iliac veins were used. The average cryopreserve time was 14 days (range, 3-44 days). Anastomosis were all successful; after cryopreservation, the blood vessels texture and elasticity were fit for surgery. No easily tearing or severe suture bleeding was observed. In 30 patients, 6 had segment V veins reconstruction; 3 had segment VIII; and 21 had both segments V and VIII. The patency rate of reconstructed vessels was 93% at 1 week, 90% at 2 weeks, 90% at 1 month, and 67% at 3 months. No serious complication was observed in donors. The prognosis was good with no small-for-size syndrome.
Cryopreserved iliac vein is an ideal material for the right hepatic living donor liver transplantation in the reconstruction of middle hepatic vein.
总结应用冷冻保存的髂静脉进行肝中静脉重建的活体肝移植经验。
2006年7月至2009年6月，85例接受活体肝移植的患者中有37例行无肝中静脉的右肝移植；其中37例中的30例采用冷冻保存的髂静脉进行肝中静脉重建。男性27例，女性3例，年龄10至57岁（中位年龄44岁）。30例患者中包括11例肝细胞癌、10例肝硬化、2例威尔逊病、1例胆管癌、1例肝母细胞瘤、1例先天性肝纤维化、1例慢性重型肝炎和1例先天性胆道闭锁。取自供体的髂静脉放入0-4℃含混合抗生素的盐水中，运送至手术室。将髂静脉修剪后，放入无菌袋（含RMPI 1640+20%二甲基亚砜+10%小牛蛋白溶液），于-70℃冷冻。在活体肝移植过程中，将静脉融化后用于肝中静脉重建。术后定期行多普勒超声检查或增强CT监测静脉通畅情况3个月。
30例患者共使用30条髂静脉。平均冷冻保存时间为14天（范围3-44天）。吻合均成功；冷冻保存后血管质地和弹性适合手术。未观察到易撕裂或严重缝合出血情况。30例患者中，6例行Ⅴ段静脉重建；3例行Ⅷ段重建；21例行Ⅴ段和Ⅷ段重建。重建血管1周通畅率为93%，2周为90%，1个月为90%，3个月为67%。供体未观察到严重并发症。预后良好，无小肝综合征。
冷冻保存的髂静脉是右半肝活体肝移植中肝中静脉重建的理想材料。
