Research Center of Chinese Health Ministry on Transplantation Medicine Engineering and Technology, The Third Xiangya Hospital, Central South University, Changsha 410013, China.
Hepatobiliary Pancreat Dis Int. 2012 Aug 15;11(4):429-33. doi: 10.1016/s1499-3872(12)60203-3.
The piggy-back caval anastomosis technique is widely used in orthotopic liver transplantation although it carries an increased risk of complications, including outflow obstruction and Budd-Chiari syndrome. The aim of this study is to clarify the anatomy and variations of hepatic veins (HVs) draining into the inferior vena cava (IVC), and to classify the surgical techniques of piggy-back liver transplantation (PBLT) based on the anatomy of HVs which can reduce the occurrence of complications.
PBLT was performed in 248 consecutive cases at our hospital from January 2004 to August 2011. The anatomy of recipients' HVs was determined when removing the native diseased livers. Both anatomy of HVs and short HVs draining into the IVC were recorded. These data were collected and analyzed.
We classified anatomic variations of HVs in the 248 livers into five types according to the way of drainage into the IVC: type I (trunk type of left and middle HVs), 142 (57.3%) patients; type II (trunk type of right and middle HVs), 54 (21.8%); type III (trunk type of left, middle and right HVs), 14 (5.6%); type IV (non-trunk type of left, middle and right HVs), of which, type IVa, 16 (6.5%), in the same horizontal plane; type IVb, 18 (7.3%), in different horizontal planes; and type V (segment type), 4 (1.6%). The patients whose HVs anatomy belonged to types I, II and III underwent classical piggy-back liver transplantation. Type IVa patients had classical PBLT via HV venoplasty prior to piggy-back anastomosis, while type IVb patients and type V patients could only have modified PBLT.
This study demonstrates that HVs can be classified according to the anatomy of their drainage into the IVC and we can use this classification to choose the best operative approach to PBLT.
背驮式腔静脉吻合术在原位肝移植中被广泛应用，尽管它会增加并发症的风险，包括流出道梗阻和布加氏综合征。本研究旨在阐明流入下腔静脉（IVC）的肝静脉（HV）的解剖结构和变异，并根据 HV 的解剖结构对背驮式肝移植（PBLT）的手术技术进行分类，以减少并发症的发生。
我院自 2004 年 1 月至 2011 年 8 月连续对 248 例患者进行了 PBLT。在切除供体病变肝脏时确定受体 HV 的解剖结构。记录 HV 的解剖结构和流入 IVC 的短 HV。收集并分析这些数据。
我们根据 HV 流入 IVC 的方式将 248 例肝脏的 HV 解剖变异分为五型：I 型（左中 HV 干型），142 例（57.3%）；II 型（右中 HV 干型），54 例（21.8%）；III 型（左中右 HV 干型），14 例（5.6%）；IV 型（非左中右 HV 干型），其中 IVa 型 16 例（6.5%），在同一水平面上；IVb 型 18 例（7.3%），在不同的水平面上；V 型（节段型），4 例（1.6%）。HV 解剖属于 I、II 和 III 型的患者行经典背驮式肝移植。IVa 型患者行 HV 静脉成形术的经典 PBLT，然后行背驮式吻合术，而 IVb 型和 V 型患者只能行改良 PBLT。
本研究表明，可以根据 HV 流入 IVC 的解剖结构对 HV 进行分类，我们可以根据分类选择最佳的 PBLT 手术方法。
