Fujimoto M, Moriyasu F, Nada T, Suginoshita Y, Ito Y, Nishikawa K, Someda H, Okuma M, Inomata Y, Ozaki N
First Department of Internal Medicine, Kyoto University, Japan.
Transplantation. 1995 Jul 15;60(1):41-5. doi: 10.1097/00007890-199507150-00008.
We investigated the influence of spontaneous portosystemic collateral pathways on the portal hemodynamics and examined the necessity for ligating these vessels in pediatric liver transplantation from living donors. We assessed portal blood flow before, during, and after surgery in 82 pediatric recipients (mean age, 4.2 years), using Doppler ultrasonography. When blood flow in the reconstructed portal vein was decreased (< 10 ml/min/kg body weight) and portosystemic collaterals persisted during surgery, those vessels were ligated and Doppler flowmetry was examined again. Spontaneous portosystemic collaterals were detected at one or more sites in 67 patients before transplantation. These collaterals had been ligated in 17 patients before intraoperative flowmetry. Among the remaining 50 patients, initial Doppler studies revealed a decrease in portal blood flow in 22 patients. Nine patients had hepatofugal splenic venous flow and 6 had no significant flow signals from the intrahepatic portal vein. Ligation of collaterals resulted in a remarkable increase in portal blood flow in 20 patients, all of whom are alive. The remaining 2 patients died of graft failure due in part to portal hypoperfusion. On the other hand, the collaterals were not ligated in 24 patients because adequate portal blood flow was confirmed by intraoperative flowmetry. Postoperatively, flow signals from the unligated collateral vessels gradually diminished, but they still persisted in 3 patients at 12 months after transplantation. Hepatofugal blood flow through the portosystemic collateral pathways may persist after implantation of a normal graft. If the patent collaterals significantly reduce the effective portal blood flow, these vessels should be ligated in order to avoid graft failure.
我们研究了自发性门体分流途径对门静脉血流动力学的影响，并探讨了在活体供肝小儿肝移植中结扎这些血管的必要性。我们使用多普勒超声检查评估了82例小儿受者（平均年龄4.2岁）手术前、手术中和手术后的门静脉血流。当重建门静脉的血流减少（<10 ml/min/kg体重）且手术中门体分流持续存在时，结扎这些血管并再次检查多普勒血流仪。67例患者在移植前在一个或多个部位检测到自发性门体分流。其中17例患者在术中血流测量前已结扎这些分流。在其余50例患者中，最初的多普勒研究显示22例患者门静脉血流减少。9例患者脾静脉血流离肝，6例肝内门静脉无明显血流信号。结扎分流导致20例患者门静脉血流显著增加，所有这些患者均存活。其余2例患者死于移植失败，部分原因是门静脉灌注不足。另一方面，24例患者未结扎分流，因为术中血流测量证实门静脉血流充足。术后，未结扎的分流血管的血流信号逐渐减弱，但在移植后12个月仍有3例患者持续存在。植入正常移植物后门体分流途径的离肝血流可能持续存在。如果开放的分流显著减少有效门静脉血流，则应结扎这些血管以避免移植失败。
