Nakamura S, Sakaguchi S, Hachiya T, Suzuki S, Nishiyama R, Konno H, Muro H, Baba S
Second Department of Surgery, Hamamatsu University School of Medicine, Japan.
Surgery. 1993 Jul;114(1):59-64.
To preserve remnant liver function, hepatectomy combined with hepatic vein (HV) reconstruction was performed in resection of the tumor located at the confluence of the HV and inferior vena cava.
Eight patients underwent HV reconstruction: the right HV in three, the middle HV in four, and the left HV in one. An external iliac vein graft was used in two patients, a superficial femoral vein graft in three, and a long saphenous vein graft in one. In one patient a patch graft was applied to the right HV; another patient underwent end-to-end anastomosis of the right HV without grafting.
There were no operative deaths and liver function was adequate throughout the postoperative period. Complications included two cases of minor biliary fistula. The middle HV with a saphenous graft and the left HV with an external iliac graft became occluded because of size mismatch at the anastomosis. Six veins were patent at 1 month and three were still patent after 30 months.
To prevent graft occlusion, it is important to select an autologous vein of optimal size and avoid inflammation of the liver stump. HV reconstruction appears to be a new surgical option for patients undergoing hepatectomy.
为保留残余肝功能，在切除位于肝静脉（HV）与下腔静脉汇合处的肿瘤时，实施了肝切除术联合肝静脉重建术。
8例患者接受了肝静脉重建术：3例重建右肝静脉，4例重建中肝静脉，1例重建左肝静脉。2例患者使用髂外静脉移植物，3例使用股浅静脉移植物，1例使用大隐静脉移植物。1例患者对右肝静脉采用补片移植；另1例患者未进行移植，对右肝静脉进行了端端吻合。
无手术死亡病例，术后整个时期肝功能良好。并发症包括2例轻度胆瘘。中肝静脉采用大隐静脉移植物以及左肝静脉采用髂外静脉移植物因吻合处尺寸不匹配而闭塞。6条静脉在1个月时通畅，3条在30个月后仍保持通畅。
为防止移植物闭塞，选择尺寸合适的自体静脉并避免肝残端炎症很重要。肝静脉重建术似乎是接受肝切除术患者的一种新的手术选择。
