Kim Joo Dong, Choi Dong Lak, Han Young Seok
Division of Hepatobiliary Pancreas Surgery and Abdominal Organ Transplantation, Department of Surgery, Catholic University of Daegu College of Medicine, Daegu, Korea.
Clin Transplant. 2014 May;28(5):561-8. doi: 10.1111/ctr.12355. Epub 2014 Apr 16.
Middle hepatic vein (MHV) reconstruction is often essential to avoid hepatic congestion and serious graft dysfunction in living donor liver transplantation (LDLT). The aim of this report was to introduce evolution of our MHV reconstruction technique and excellent outcomes of simplified one-orifice venoplasty. We compared clinical outcomes with two reconstruction techniques through retrospective review of 95 recipients who underwent LDLT using right lobe grafts at our institution from January 2008 to April 2012; group 1 received separate outflow reconstruction and group 2 received new one-orifice technique. The early patency rates of MHV in group 2 were higher than those in group 1; 98.4% vs. 88.2% on postoperative day 7 (p = 0.054) and 96.7% vs. 82.4% on postoperative day 14, respectively (p = 0.023). Right hepatic vein (RHV) stenosis developed in three cases in group 1, but no RHV stenosis developed because we adopted one-orifice technique (p = 0.043). The levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in group 2 were significantly lower than those in group 1 during the early post-transplant period. In conclusion, our simplified one-orifice venoplasty technique could secure venous outflow and improve graft function during right lobe LDLT.
在活体肝移植（LDLT）中，肝中静脉（MHV）重建对于避免肝淤血和严重的移植物功能障碍通常至关重要。本报告的目的是介绍我们的MHV重建技术的演变以及简化单孔静脉成形术的良好效果。我们通过回顾性分析2008年1月至2012年4月在我院接受右叶移植的95例LDLT受者，比较了两种重建技术的临床结果；第1组接受单独的流出道重建，第2组接受新的单孔技术。第2组MHV的早期通畅率高于第1组；术后第7天分别为98.4%对88.2%（p = 0.054），术后第14天分别为96.7%对82.4%（p = 0.023）。第1组有3例发生右肝静脉（RHV）狭窄，但由于我们采用了单孔技术，未发生RHV狭窄（p = 0.043）。移植后早期，第2组的天冬氨酸转氨酶（AST）和丙氨酸转氨酶（ALT）水平显著低于第1组。总之，我们简化的单孔静脉成形术技术可以确保右叶LDLT期间的静脉流出并改善移植物功能。
