Park S, Cho A, Arimitsu H, Iwase T, Yanagibashi H, Ota T, Kainuma O, Yamamoto H, Imamura A, Takano H
Division of Gastroenterological Surgery, Chiba Cancer Center Hospital, Chuo-ku, Chiba, Japan.
Transplant Proc. 2013 Jan-Feb;45(1):212-7. doi: 10.1016/j.transproceed.2012.02.044.
Living donor liver transplantation is widely performed in adult patients. One of the problems in this setting is a small-for-size graft, which results in dysfunction and poor prognosis of a transplantation. A right liver graft was devised to overcome this problem; furthermore, inclusion of the middle hepatic vein (MHV) has been suggested to greatly improve recipient outcomes. However, extended right hepatectomy involves a surgical risk for the living donor in terms of congestion of the left paramedian sector. The volume of the venoocclusive region of a living donor liver possibly varies depending on the collateral patterns of veins draining the cranial part of segment 4 (S4).
We were analyzed the normal livers of 50 patients who underwent triphasic contrast-enhanced multidetector row computed tomography during preoperative and postoperative examinations. The patient pathologies consisted of gastric cancer (n = 25), colon cancer (n = 1), or renal cancer (n = 24). We calculated the volume of the entire liver as well as those of the right graft and left remnant lobes for comparison with the drainage volume of each hepatic vein and its branches.
On the basis of the anatomic venous drainage of the cranial part of S4 (V4sup), we classified hepatic veins as group A (n = 31), the V4sup joined the left hepatic vein or the MHV distal to the vein draining S8 area (MV8), or group B (n = 19), V4sup joined the MHV proximal to MV8. The mean volume of the congested area was 6.9% in group A and 15.9% in group B. The venoocclusive areas in the remnant livers were estimated to be larger in group B (P < .001).
The collateral pattern of V4sup and MV8 as well as preoperative volumetric analysis are important for graft selection to decide the line of transection.
活体肝移植在成年患者中广泛开展。这种情况下的一个问题是小体积供肝，这会导致移植功能障碍和预后不良。为克服这一问题设计了右肝移植物；此外，有人提出纳入肝中静脉（MHV）可显著改善受者结局。然而，扩大右半肝切除术对活体供者而言存在手术风险，即左旁正中肝段充血。活体供肝的静脉闭塞区域体积可能因引流第4肝段（S4）头侧部分的静脉侧支循环模式而异。
我们分析了50例在术前和术后检查期间接受三期对比增强多层螺旋CT检查的患者的正常肝脏。患者的病理类型包括胃癌（n = 25）、结肠癌（n = 1）或肾癌（n = 24）。我们计算了全肝以及右肝移植物和左肝残余叶的体积，以便与各肝静脉及其分支的引流体积进行比较。
根据S4头侧部分（V4sup）的解剖静脉引流情况，我们将肝静脉分为A组（n = 31），V4sup在引流S8区域的静脉（MV8）远端汇入左肝静脉或MHV；或B组（n = 19），V4sup在MV8近端汇入MHV。A组充血区域的平均体积为6.9%，B组为15.9%。估计B组残余肝脏的静脉闭塞区域更大（P < .001）。
V4sup和MV8的侧支循环模式以及术前容积分析对于决定横断线的移植物选择很重要。
