右半肝活体供肝残肝的再生与静脉侧支形成：节段性容积分析及三维可视化。

Liver regeneration and venous collateral formation in the right lobe living-donor remnant: segmental volumetric analysis and three-dimensional visualization.

机构信息

Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi, Higashi-ku, Fukuoka, Japan.

出版信息

Transplantation. 2013 Jan 27;95(2):353-60. doi: 10.1097/TP.0b013e31827147d8.

DOI:10.1097/TP.0b013e31827147d8

PMID:23325006

Abstract

BACKGROUND

In left lobe (LL) living-donor liver transplantation (LDLT), hepatic venous congestion (HVC) caused by ligation of the middle hepatic vein tributaries is unavoidable in the right lobe (RL) donor remnant.

METHODS

To clarify the impact of HVC on liver regeneration and venous collateral formation (VCF), we used three-dimensional computed tomography to examine the volumes of total/segmental liver and HVC and the degree of VCF; preoperative data were compared with data obtained on postoperative day (POD) 35 in 13 LL LDLT donors.

RESULTS

On POD 35, the congestion rate decreased from 32.5% to 1.6% and the total liver regeneration rate was 81.7%. Preoperatively, the anterior sector-to-RL volume ratio was significantly lower, and the posterior sector-to-RL volume ratio was significantly higher than postoperatively (56.7% vs. 52.9%, P<0.01, and 36.9% vs. 41.5%, P<0.01, respectively). There was no correlation between degree of HVC and liver regeneration. Obvious VCF was found in five (38.5%) cases. The RL and posterior sector volume per square meter of body surface area in the VCF group were significantly lower than that in the non-VCF group (412 cm/m vs. 492 cm/m, P<0.01, and 140 cm/m vs. 190 cm/m, P<0.01, respectively). The preoperative congestion rate and liver regeneration rate were not significantly different between the groups.

CONCLUSIONS

Reconstruction of the middle hepatic vein tributaries in the RL donor remnant might not be necessary in LL LDLT, because the HVC improved dramatically by POD 35 regardless of the development of VCF.

摘要

背景

在左叶（LL）活体肝移植（LDLT）中，右叶（RL）供体残肝中结扎肝中静脉属支不可避免地会导致肝静脉淤血（HVC）。

方法

为了阐明 HVC 对肝再生和静脉侧支形成（VCF）的影响，我们使用三维计算机断层扫描检查总/节段肝和 HVC 的体积以及 VCF 的程度；将术前数据与 13 例 LL LDLT 供体术后第 35 天（POD）获得的数据进行比较。

结果

在 POD 35 时，淤血率从 32.5%下降至 1.6%，总肝再生率为 81.7%。术前，前叶与 RL 体积比显著降低，后叶与 RL 体积比显著升高（56.7%比 52.9%，P<0.01，和 36.9%比 41.5%，P<0.01）。HVC 程度与肝再生无相关性。5 例（38.5%）发现明显的 VCF。VCF 组 RL 和后叶每平方米体表面积的体积明显低于非 VCF 组（412cm/m 比 492cm/m，P<0.01，和 140cm/m 比 190cm/m，P<0.01）。两组间术前淤血率和肝再生率无显著差异。