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右半肝活体肝移植供体门静脉的解剖变异:变异门静脉的安全应用。

Anatomical variations of donor portal vein in right lobe living donor liver transplantation: the safe use of variant portal veins.

机构信息

Center for Organ Transplantation, Florence Nightingale Hospital, Istanbul, Turkey.

出版信息

Transpl Int. 2013 Dec;26(12):1191-7. doi: 10.1111/tri.12190. Epub 2013 Oct 15.

Abstract

In right lobe (RL) living donor liver transplantation (LDLT), portal vein (PV) variations are of immense clinical significance. In this study, we describe in detail our PV reconstruction techniques in RL grafts with variant PV anatomy and evaluate the impact of accompanying biliary variations on the recipient outcomes. In a total of 386 RL LDLTs performed between July 2004 and July 2012, the clinical data on 52 (13%) transplants using RL grafts with variant PV anatomy were retrospectively analyzed. Portal vein anatomy was classified as type 2 in 20 patients, type 3 in 24 patients, and type 4 in eight patients. The PV reconstruction techniques utilized included back-wall plasty (n = 21), back-wall plasty with saphenous vein graft interposition (n = 6), saphenous vein graft interposition (n = 5), cryopreserved iliac vein Y-graft interposition (n = 6), and quiltplasty (n = 3). There was no donor mortality. In a median follow-up of 29 months, none of the recipients had vascular complications. Anomalous PV anatomy was associated with a high (54%) incidence of biliary variations; however, these variations did not result in increased biliary complication rate. Overall, the 1- and 3-year patient survival rates of recipients were 91% and 81%, respectively. Vascular and biliary variations in RL grafts render LDLT technically more challenging. By employing appropriate reconstruction techniques, it is possible to successfully use RL grafts with PV variations without endangering recipient and donor safety.

摘要

在右半肝(RL)活体肝移植(LDLT)中,门静脉(PV)变异具有重要的临床意义。本研究详细描述了我们在具有变异 PV 解剖结构的 RL 供肝中进行的 PV 重建技术,并评估了伴随的胆道变异对受者结局的影响。在 2004 年 7 月至 2012 年 7 月期间进行的总共 386 例 RL LDLT 中,回顾性分析了 52 例(13%)使用具有变异 PV 解剖结构的 RL 供肝的移植病例。门静脉解剖学分为 20 例 2 型,24 例 3 型,8 例 4 型。PV 重建技术包括后壁成形术(n = 21)、后壁成形术加大隐静脉移植桥接(n = 6)、大隐静脉移植桥接(n = 5)、冷冻保存髂静脉 Y 型移植桥接(n = 6)和 quiltplasty(n = 3)。供者无死亡。中位随访 29 个月,受者无血管并发症。异常的 PV 解剖结构与胆道变异的高发生率(54%)相关;然而,这些变异并未导致胆道并发症发生率增加。总的来说,受者的 1 年和 3 年生存率分别为 91%和 81%。RL 供肝的血管和胆道变异使 LDLT 技术更具挑战性。通过采用适当的重建技术,有可能在不危及供者和受者安全的情况下成功使用具有 PV 变异的 RL 供肝。

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