Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.
Laboratory of Liver Transplantation, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital of Sichuan University, Chengdu, China.
Transpl Int. 2022 Jan 12;35:10177. doi: 10.3389/ti.2021.10177. eCollection 2021.
There are two causes of graft compression in the large-for-size syndrome (LFSS). One is a shortage of intra-abdominal space for the liver graft, and the other is the size discrepancy between the anteroposterior dimensions of the liver graft and the lower right hemithorax of the recipient. The former could be treated using delayed fascial closure or mesh closure, but the latter may only be treated by reduction of the right liver graft to increase space. Given that split liver transplantation has strict requirements regarding donor and recipient selections, reduced-size liver transplantation, in most cases, may be the only solution. However, surgical strategies for the reduction of the right liver graft for adult liver transplantations are relatively unfamiliar. Herein, we introduce a novel strategy of HuaXi- right posterior sectionectomy while preserving the right hepatic vein in the graft to prevent LFSS and propose its initial indications.
在大小肝综合征 (LFSS) 中，移植物压迫有两个原因。一是肝移植物在腹腔内的空间不足，二是肝移植物的前后径与受体右下胸腔之间存在大小差异。前者可以通过延迟筋膜闭合或网片闭合来治疗，但后者可能只能通过减少右肝移植物来增加空间。鉴于劈裂肝移植对供体和受体的选择有严格的要求，大多数情况下，减小肝移植物的体积可能是唯一的解决方法。然而，成人肝移植中右肝移植物减小的手术策略相对不熟悉。在此，我们介绍一种在保留供肝右肝静脉的情况下进行右后叶切除术的新策略，以防止 LFSS 的发生，并提出其初步适应证。
