Shimizu S, Onoe T, Ishiyama K, Ide K, Ohira M, Tahara H, Saeki Y, Kobayashi T, Kuroda S, Tashiro H, Ohdan H
Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Institute for Clinical Research, National Hospital Organization Kure Medical Center/Chugoku Cancer Center, Kure, Japan.
Transplant Proc. 2014 Apr;46(3):982-5. doi: 10.1016/j.transproceed.2013.11.105.
Maintaining hepatic inflow and appropriate venous drainage is important for maximizing the capacity of the retrieved graft in liver transplantation. Here, we report a successful case of multiple hepatic vein (HV) reconstruction using an all-in-one sleeve patch graft of the autologous great saphenous vein to ensure adequate blood flow through the HV. A patient with hepatocellular carcinoma caused by hepatitis C virus-induced cirrhosis underwent living donor liver transplantation using a right lobe graft. A preoperative dynamic computed tomography scan and intraoperative findings revealed that the graft had three middle HV tributaries, a superficial vein, segment VIII HV (V8), and segment V HV (V5). The openings of the superficial vein and V8 were located very close to that of the right hepatic vein (RHV) in the cutting surface. Each HV had significant diameter and drainage territory requiring reconstruction. An autologous great saphenous vein was used to create a sleeve patch to incorporate the close-packed HV openings. The autologous sleeve patch graft was sutured to the openings of the RHV and the superficial vein and the hole created on the sleeve patch graft was anastomosed to the openings of V8 directly on the back table to create an all-in-one sleeve patch. For the V5 reconstruction, the recipient's intrahepatic portal vein graft was used to create an interpositional conduit from the recipient's V5 to the inferior vena cava. The postoperative course was uneventful and postoperative studies revealed good graft function with excellent blood flow in the HV.
维持肝脏血流和适当的静脉引流对于最大化肝移植中获取的移植物的功能至关重要。在此，我们报告一例成功使用自体大隐静脉一体化袖状补片进行多条肝静脉（HV）重建的病例，以确保通过肝静脉有足够的血流。一名由丙型肝炎病毒引起的肝硬化导致肝细胞癌的患者接受了使用右叶移植物的活体供肝移植。术前动态计算机断层扫描和术中发现显示，移植物有三条肝中静脉分支、一条浅表静脉、肝VIII段静脉（V8）和肝V段静脉（V5）。在切面上，浅表静脉和V8的开口非常靠近右肝静脉（RHV）的开口。每条肝静脉的直径和引流区域都很大，需要重建。使用自体大隐静脉制作一个袖状补片，以合并紧密排列的肝静脉开口。将自体袖状补片移植物缝合到RHV和浅表静脉的开口处，并在袖状补片移植物上制作的孔在手术台上直接与V8的开口吻合，以形成一体化袖状补片。对于V5重建，使用受者的肝内门静脉移植物创建一个从受者V5到下腔静脉的间置导管。术后过程顺利，术后检查显示移植物功能良好，肝静脉血流良好。
