Kwon Jae Hyun, Hwang Shin, Song Gi-Won, Moon Deok-Bog, Park Gil-Chun, Kim Seok-Hwan, Lee Sung-Gyu
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Hepatobiliary Pancreat Surg. 2016 May;20(2):61-5. doi: 10.14701/kjhbps.2016.20.2.61. Epub 2016 May 11.
Anomalous portal vein (PV) branching of the donor liver is uncommon and usually makes two, or rarely, more separate PV branches at the right liver graft. Autologous PV Y-graft interposition has long been regarded as the standard procedure, but is currently replaced with the newly developed technique of conjoined unification venoplasty (CUV) due to its superior results. Herein, we presented a case of CUV application to three PV openings of a right liver graft. The recipient was a 32-year-old male patient with hepatitis B virus-associated liver cirrhosis. The living liver donor was his 33-year-old sister who had a type III PV anomaly, but the right posterior PV branch was bifurcated early into separate branches of the segments VI and VII, thus three right liver PV branches were cut separately. We used the CUV technique consisting of placement of a small vein unification patch between three PV orifices, followed by overlying coverage with a crotch-opened autologous portal Y-graft. The portal Y-graft was excised and its crotches were incised to make a wide common orifice. Three bidirectional running sutures were required to attach the crotch-opened autologous portal Y-graft. After portal reperfusion, the conjoined PV portion bulged like a tennis ball, providing a wide range of alignment tolerance. The patient recovered uneventfully from the liver transplantation operation. The CUV technique enabled uneventful reconstruction of triple donor PV orifices. Thus, CUV can be a useful and effective technical option for reconstruction of right liver grafts with various anomalous PVs.
供体肝脏门静脉（PV）分支异常并不常见，通常在右肝移植物处形成两个或很少情况下更多个独立的PV分支。自体PV Y形移植一直被视为标准术式，但由于其效果更佳，目前已被新开发的联合统一静脉成形术（CUV）所取代。在此，我们报告了一例将CUV应用于右肝移植物三个PV开口的病例。受者是一名32岁的男性乙肝病毒相关性肝硬化患者。活体肝供体是他33岁的姐姐，其PV存在III型异常，但右后PV分支早期分叉为VI段和VII段的独立分支，因此右肝的三个PV分支被分别切断。我们采用的CUV技术包括在三个PV孔之间放置一个小静脉统一补片，然后用劈开裆部的自体门静脉Y形移植物覆盖。切除门静脉Y形移植物并切开其裆部以形成一个宽大的共同开口。需要三根双向连续缝合线来连接劈开裆部的自体门静脉Y形移植物。门静脉再灌注后，联合PV部分像网球一样鼓起，提供了广泛的对齐耐受性。患者肝移植手术后恢复顺利。CUV技术实现了对供体三个PV孔的顺利重建。因此，CUV对于各种PV异常的右肝移植物重建可能是一种有用且有效的技术选择。
