Departments of Liver Surgery, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
Ultrasonography, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
Liver Transpl. 2018 Aug;24(8):1084-1090. doi: 10.1002/lt.25011. Epub 2018 Apr 17.
A stenotic or hypoplastic portal vein (PV) represents a challenge for PV reconstruction in pediatric living donor liver transplantation (LDLT). Several PV venoplastic techniques have been developed. However, we still seek improved venoplastic techniques with better efficacy and compatibility. From June 2016 to July 2017, 271 LDLT procedures were performed at the Department of Liver Surgery, Renji Hospital. A total of 16 consecutive children with stenotic and sclerotic PVs underwent a novel technique-the autogenous PV patch plastic technique. Vessel patches were procured from the left branch (LB), or the bifurcation of the right branch and LB of the PV in the native liver. Then, the PVs were enlarged by suturing the patches along the longitudinal axis from the confluence of the PV and coronary vein (CV). In this series, 15/16 achieved good intraoperational PV flow, and 1 showed low PV flow but was treated with stent placement. Within a median follow-up of 11 months (1-18 months), 15 patients were alive and had normal graft function, whereas 1 child died from lung infection 1 month after transplantation. No PV complications were detected. In conclusion, the autogenous patch venoplasty technique using the PV-CV confluence is simple and safe. This novel venoplastic reconstruction technique could serve as a surgical option to achieve satisfactory outcomes, especially those with stenotic PV (<4.5 mm) and dilated CV (>3.0 mm). Liver Transplantation 2018 AASLD.
狭窄或发育不良的门静脉（PV）代表了小儿活体供肝移植（LDLT）中 PV 重建的挑战。已经开发了几种 PV 静脉成形技术。然而，我们仍在寻求具有更好疗效和相容性的改良静脉成形技术。2016 年 6 月至 2017 年 7 月，仁济医院肝外科完成了 271 例 LDLT 手术。共有 16 例连续狭窄和硬化性 PV 患儿采用了一种新的技术——自体 PV 补片成形技术。血管补片取自供肝的左支（LB）或右支和 LB 的分叉处。然后，通过沿 PV 和冠状静脉（CV）汇合处的纵轴缝合补片来扩大 PV。在本系列中，15/16 例术中 PV 血流良好，1 例 PV 血流低，但通过支架置入术治疗。中位随访 11 个月（1-18 个月），15 例患者存活且移植物功能正常，而 1 例患儿在移植后 1 个月因肺部感染死亡。未发现 PV 并发症。总之，使用 PV-CV 汇合处的自体补片静脉成形术简单安全。这种新的静脉成形重建技术可以作为一种手术选择，以获得满意的结果，尤其是那些 PV 狭窄（<4.5mm）和 CV 扩张（>3.0mm）的患者。肝移植 2018 AASLD。
