Department of General Surgery Huashan Hospital Fudan University Shanghai China.
Liver Transpl. 2021 Jan;27(1):88-95. doi: 10.1002/lt.25793. Epub 2020 Aug 6.
We assess the safety and feasibility of the left hepatic vein preferential approach (LHVPA) based on left hepatic vein (LHV) anatomy for living donor laparoscopic left lateral sectionectomy (LLLS). Data from 50 donors who underwent LLLS in Huashan Hospital from October 2016 to November 2019 were analyzed retrospectively. On the basis of the classification of the LHV anatomy, the vein was defined as the direct import type, upper branch type, or indirect import type. A subgroup analysis was performed to compare the outcomes between the LHVPA and non-LHVPA groups. All 50 patients underwent pure LLLS. The mean operative duration was 157.5 ± 29.7 minutes. The intraoperative blood loss was 160.4 ± 97.5 mL. No complications more severe than grade 3 occurred. LHVPA was applied in 13 patients, whereas non-LHVPA was applied in 10 patients with the direct import type and upper branch type anatomy. The operative duration was shorter in the LHVPA group than the non-LHVPA group (142.7 ± 22.0 versus 173.0 ± 22.8 minutes; P = 0.01). Intraoperative blood loss was reduced in the LHVPA group compared with the non-LHVPA group (116.2 ± 45.6 versus 170.0 ± 63.3 mL; P = 0.02). The length of the LHV reserved extrahepatically in the LHVPA group was longer than in the non-LHVPA group (4.3 ± 0.2 versus 3.3 ± 0.3 mm; P = 0.01). Fewer reconstructions of the LHV in the direct import type anatomy were required for the LHVPA group than for the non-LHVPA group (0/8 versus 4/6). LHVPA based on the LHV anatomy is recommended in LLLS because it can further increase the safety and the efficiency of surgery for suitable donors.
我们评估了基于左肝静脉（LHV）解剖结构的左肝静脉优先入路（LHVPA）在活体供体腹腔镜左外叶切除术（LLLS）中的安全性和可行性。回顾性分析了 2016 年 10 月至 2019 年 11 月在华山医院接受 LLLS 的 50 例供者的数据。根据 LHV 解剖结构的分类，静脉被定义为直接导入型、上支型或间接导入型。进行了亚组分析，以比较 LHVPA 组和非 LHVPA 组之间的结果。所有 50 例患者均行纯 LLLS。平均手术时间为 157.5±29.7 分钟。术中出血量为 160.4±97.5mL。未发生 3 级以上的并发症。13 例患者采用 LHVPA，10 例直接导入型和上支型解剖结构患者采用非 LHVPA。LHVPA 组的手术时间短于非 LHVPA 组（142.7±22.0 分钟比 173.0±22.8 分钟；P=0.01）。LHVPA 组术中出血量少于非 LHVPA 组（116.2±45.6 毫升比 170.0±63.3 毫升；P=0.02）。LHVPA 组肝外保留的 LHV 长度长于非 LHVPA 组（4.3±0.2 毫米比 3.3±0.3 毫米；P=0.01）。对于直接导入型解剖结构，LHVPA 组需要进行 LHV 重建的比例低于非 LHVPA 组（0/8 比 4/6）。基于 LHV 解剖结构的 LHVPA 推荐用于 LLLS，因为它可以进一步提高手术的安全性和效率，适用于合适的供者。
