Sakamoto Katsunori, Ogawa Kohei, Matsui Takashi, Utsunomiya Takeshi, Honjo Masahiko, Ueno Yoshitomo, Tamura Kei, Inoue Hitoshi, Nakamura Taro, Watanabe Jota, Takai Akihiro, Tohyama Taiji, Takada Yasutsugu
Department of Surgery, Ehime University Hospital, Ehime, Japan.
Department of Surgery, Ehime University Hospital, Ehime, Japan.
Transplant Proc. 2019 Jun;51(5):1506-1510. doi: 10.1016/j.transproceed.2019.01.118. Epub 2019 Apr 19.
Congestion of the anterior section of the grafted liver might be a problem when performing living donor liver transplant using a right lobe graft without middle hepatic vein (MHV). This can be prevented by MHV tributary reconstruction. We report our procedure and results of reconstructing MHV tributaries using artificial vascular grafts (AVGs).
We consider venous reconstruction when the estimated territory of each MHV tributary of the transplanted liver is more than 100 mL. For tributaries distant from the stump of the right hepatic vein of the graft, we use heparin-bonded AVGs made of expanded polytetrafluoroethylene with circular rings as the interposition graft between the MHV tributary and the inferior vena cava. During donor surgery, the suturing margin of the MHV tributary is secured before cutting, and it is anastomosed to the AVG during back-bench surgery. After restoration of portal flow in the recipient, we anastomose the AVG at a new position on the inferior vena cava.
The above procedure was performed for 4 cases. The estimated drainage territory of the vein that was reconstructed using the AVG ranged from 104 to 180 mL. The AVG patency was achieved for about 2 months in all cases. In terms of morbidity, biloma and pancreatic fistula were observed in 2 cases, although removal of the AVG was not required postoperatively in any of the cases.
The heparin-bonded expanded polytetrafluoroethylene AVG with circular rings is a feasible option for MHV tributary reconstruction in living donor liver transplant using right liver lobe grafts without MHVs.
在使用无肝中静脉（MHV）的右叶移植物进行活体肝移植时，移植肝前段的充血可能是一个问题。这可以通过重建MHV分支来预防。我们报告了使用人工血管移植物（AVG）重建MHV分支的手术方法及结果。
当估计移植肝各MHV分支的供血区域超过100 mL时，我们考虑进行静脉重建。对于距离移植物右肝静脉残端较远的分支，我们使用由带环形结构的膨体聚四氟乙烯制成的肝素结合AVG作为MHV分支与下腔静脉之间的间置移植物。在供体手术期间，在切断MHV分支之前确保其缝合边缘，然后在体外手术中将其与AVG吻合。在受体门静脉血流恢复后，我们将AVG吻合在下腔静脉的新位置。
上述手术共进行了4例。使用AVG重建的静脉估计引流区域为104至180 mL。所有病例中AVG均通畅约2个月。在发病率方面，2例观察到胆汁瘤和胰瘘，尽管所有病例术后均无需取出AVG。
带环形结构的肝素结合膨体聚四氟乙烯AVG是在使用无MHV的右肝叶移植物进行活体肝移植时重建MHV分支的可行选择。
