门静脉类型对供体残余肝体积的影响：术前 CT 评估。

Effect of Portal Vein Types on Estimated Remnant Volume in Living Donor: Preoperative CT Assessment.

机构信息

Radiology Department, Koc University Hospital, Davutpasa Caddesi No:4 Topkapi, Zeytinburnu, Istanbul, Turkey.

出版信息

Jpn J Radiol. 2024 Nov;42(11):1236-1242. doi: 10.1007/s11604-024-01610-7. Epub 2024 Jun 13.

DOI:10.1007/s11604-024-01610-7

PMID:38867034

Abstract

PURPOSE

The aim of this study is to examine the effect of portal vein types on the ratio of the right-left lobe liver volumes, as well as the insufficient estimated remnant liver volume (ERLV) during the preoperative assessment of donor candidates for right-lobe liver transplantation.

MATERIALS AND METHODS

The preoperative abdominal CT examinations of the donor candidates in a single institution between December 2018 and May 2022 were retrospectively evaluated. Portal vein types are divided into 3; classical anatomy was considered type 1, PV trifuction was considered type 2, and if the first branch arising from the main portal vein is the right posterior branch, it was accepted as type 3. Other configurations were defined as type 4. The total, right-left lobe liver volumes, the ERLV, and the portal vein variations were noted. The chi-square test was performed to assess the correlation between portal vein types, the ratio of the right-left lobe volumes, and the ERLV ratio below 30%. Tamhane's T2 post hoc tests were performed for pairwise comparison to assess the right-left lobe volume ratio among groups.

RESULTS

287 donor candidates (mean age, 35 years ± 8.2; 174 men) were evaluated. The volume ratio of median volume of the right and left lobe was significantly higher in candidates with type 3 portal veins compared to those with type 1 portal veins (2 (1.3-3.5) and 2.1 (1.6-3.2), respectively, p = 0.017). The ERLV ratio below 30% was significantly higher in donor candidates with type 3 portal veins (42.9%) compared to those with type 1 and 2 portal veins (24.6%, 20%)) respectively, p = 0.030).

CONCLUSION

Due to its propensity to result in insufficient ERLV in the donor, the presence of a type 3 portal vein should be evaluated during the preoperative evaluation. Secondary abstract: This study suggests that donor candidates with type 3 portal vein exhibit a notable rise in the frequency of insufficient remnant liver volume during the preoperative assessment.

摘要

目的

本研究旨在探讨门静脉类型对左右肝叶体积比的影响，以及在右肝叶肝移植供体候选人术前评估中估计剩余肝体积（ERLV）不足的情况。

材料和方法

回顾性分析了 2018 年 12 月至 2022 年 5 月期间单家机构供体候选人的术前腹部 CT 检查。门静脉类型分为 3 种；经典解剖学为 1 型，门静脉三分叉为 2 型，如果主门静脉的第一分支是右后支，则接受为 3 型。其他构型定义为 4 型。记录总肝、左右肝叶体积、ERLV 和门静脉变异情况。采用卡方检验评估门静脉类型、左右肝叶体积比与 ERLV 比值<30%之间的相关性。采用 Tamhane T2 事后检验进行两两比较，评估各组间左右肝叶体积比。

结果

共评估了 287 名供体候选人（平均年龄 35 岁±8.2 岁，174 名男性）。与 1 型门静脉相比，3 型门静脉的候选者右肝和左肝中叶体积比中位数明显更高（分别为 2（1.3-3.5）和 2.1（1.6-3.2），p=0.017）。3 型门静脉的供体候选人 ERLV 比值<30%的比例明显高于 1 型和 2 型门静脉（分别为 42.9%、24.6%和 20%，p=0.030）。