Liver Transplantation Program, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Transpl Int. 2012 May;25(5):586-91. doi: 10.1111/j.1432-2277.2012.01464.x. Epub 2012 Mar 26.
For pediatric living donor liver transplantation, portal vein complications cause significant morbidity and graft failure. Routine intra-operative Doppler ultrasound is performed after graft reperfusion to evaluate the flow of portal vein. This retrospective study reviewed 65 children who had undergone living donor liver transplantation. Seven patients were detected with suboptimal portal vein flow velocity following vascular reconstruction and abdominal closure. They underwent immediate on-table interventions to improve the portal vein flow. Both surgical and endovascular modalities were employed, namely, graft re-positioning, collateral shunt ligation, thrombectomy, revision of anastomosis, inferior mesenteric vein cannulation, and endovascular stenting. The ultrasonographic follow-up assessment for all seven patients demonstrated patent portal vein and satisfactory flow. We reviewed our experience on the different modalities and proposed an approach for our future intra-operative management to improve portal vein flow at the time of liver transplantation.
对于儿科活体供肝移植，门静脉并发症会导致严重的发病率和移植物失功。在进行再灌注后，通常会在术中进行多普勒超声检查，以评估门静脉的血流情况。本回顾性研究纳入了 65 例行活体供肝移植的儿童患者。7 例患者在血管重建和腹部关闭后发现门静脉血流速度不理想。他们立即接受了术中干预措施以改善门静脉血流。使用了手术和血管内两种方式，包括肝移植、侧支分流结扎、血栓切除术、吻合口修正、肠系膜下静脉插管和血管内支架置入。对所有 7 例患者的超声随访评估显示门静脉通畅，血流满意。我们回顾了不同方式的经验，并提出了我们未来术中管理的方法，以改善肝移植时门静脉血流。
