Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 812-8582, Fukuoka, Japan.
Surg Today. 2013 Jul;43(7):769-76. doi: 10.1007/s00595-012-0449-5. Epub 2012 Dec 18.
Reconstruction of the right inferior hepatic vein (RIHV) presents a major technical challenge in living donor liver transplantation (LDLT) using right lobe grafts.
We studied 47 right lobe LDLT grafts with RIHV revascularization, comparing one-step reconstruction, performed post-May 2007 (n = 16), with direct anastomosis, performed pre-May 2007 (n = 31).
In the one-step reconstruction technique, the internal jugular vein (n = 6), explanted portal vein (n = 5), inferior vena cava (n = 3), and shunt vessels (n = 2) were used as venous patch grafts for unifying the right hepatic vein, RIHVs, and middle hepatic vein tributaries. By 6 months after LDLT, there was no case of occlusion of the reconstructed RIHVs in the one-step reconstruction group, but a cumulative occlusion rate of 18.2 % in the direct anastomosis group. One-step reconstruction required a longer cold ischemic time (182 ± 40 vs. 115 ± 63, p < 0.001) and these patients had higher alanine transaminase values (142 ± 79 vs. 96 ± 46 IU/L, p = 0.024) on postoperative day POD 7. However, the 6-month short-term graft survival rates were 100 % with one-step reconstruction and 83.9 % with direct anastomosis, respectively.
One-step reconstruction of the RIHVs using auto-venous grafts is an easy and feasible technique promoting successful right lobe LDLT.
在右半肝供肝肝移植中，右肝下静脉（RIHV）的重建是一个主要的技术挑战。
我们研究了 47 例行右半肝肝移植并重建 RIHV 的患者，将采用直接吻合（2007 年 5 月前，n=31）与一步法重建（2007 年 5 月后，n=16）的患者进行对比。
在一步法重建技术中，我们使用颈内静脉（n=6）、废弃的门静脉（n=5）、下腔静脉（n=3）和分流血管（n=2）作为静脉补丁移植物，用于统一右肝静脉、RIHV 和中肝静脉属支。在肝移植后 6 个月时，一步法重建组无一例 RIHV 再通失败，而直接吻合组的累积再通失败率为 18.2%。一步法重建需要更长的冷缺血时间（182±40 比 115±63，p<0.001），并且这些患者在术后第 7 天的丙氨酸转氨酶值更高（142±79 比 96±46 IU/L，p=0.024）。然而，一步法重建组和直接吻合组的 6 个月短期移植物存活率分别为 100%和 83.9%。
使用自体静脉移植物进行 RIHV 的一步法重建是一种简单且可行的技术，可促进右半肝肝移植的成功。
