Yang Kwangho, Park Youngmok, Moon Kimyung, Ryu Jeho, Chu Chongwoo
Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea. ; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
Ann Surg Treat Res. 2014 Oct;87(4):185-91. doi: 10.4174/astr.2014.87.4.185. Epub 2014 Sep 25.
Multiple segment 5 vein (V5) anastomoses are common and inevitable in living donor liver transplantation (LDLT) using modified right lobe (MRL) graft. Sacrifice of segment 4a vein (V4a) can simplify bench work and avoid graft congestion. But it could be harmful to some donors in previous simulation studies. This study aimed to evaluate donor safety in LDLT using caudal middle hepatic vein trunk preserved right lobe (CMPRL) graft.
LDLT using MRL grafts were performed on 33 patients (group A) and LDLT using CMPRL grafts were performed on 37 patients (group B). Group B was classified into 2 subgroups by venous drainage pattern of segment 4: V4a dominant drainage group (group B1) and the other group (group B2). Parameters compared between group A donors and group B donors included operation time, bench work time, number and diameter of V5, remnant liver volume and postoperative course. Those were also investigated in group B1 compared with group B2. And, we reviewed postoperative course of the recipients in groups A and B.
Operation time and bench work time in group B were significantly shorter. There were no significant differences in most postoperative parameters between groups B1 and B2. As a result of recipient, V5 patency rates after LDLT were significantly higher in group B.
LDLT using CMPRL graft is a safe procedure for living donors. Donors with any type of V4 could be proper candidates for CMPRL graft if remnant liver volume is greater than 30% with minimal fatty change.
在使用改良右叶（MRL）移植物的活体肝移植（LDLT）中，多节段5静脉（V5）吻合常见且不可避免。牺牲4a段静脉（V4a）可简化手术台上的操作并避免移植物充血。但在以往的模拟研究中，这可能对一些供体有害。本研究旨在评估使用保留肝中静脉主干尾侧右叶（CMPRL）移植物的LDLT中供体的安全性。
对33例患者进行了使用MRL移植物的LDLT（A组），对37例患者进行了使用CMPRL移植物的LDLT（B组）。B组根据4段的静脉引流模式分为2个亚组：V4a主导引流组（B1组）和另一组（B2组）。比较A组供体和B组供体之间的参数包括手术时间、手术台上的操作时间、V5的数量和直径、残余肝体积和术后病程。B1组与B2组也进行了这些参数的研究。并且，我们回顾了A组和B组受者的术后病程。
B组的手术时间和手术台上的操作时间明显更短。B1组和B2组之间大多数术后参数无显著差异。作为受者的结果，B组LDLT后V5通畅率明显更高。
使用CMPRL移植物的LDLT对活体供体是一种安全的手术。如果残余肝体积大于30%且脂肪变最小，任何类型V4的供体都可能是CMPRL移植物的合适候选者。
