Hirose T, Inomoto T, Awane M, Shirakata Y, Nada T, Moriyasu F, Uemoto S, Inomata Y, Tanaka A, Tanaka K, Yamaoka Y
Department of Gastroenterological Surgery, Kyoto University Graduate School of Medicine, Japan.
Clin Transplant. 1998 Feb;12(1):49-55.
We investigated the incidence and manifestation of problems associated with large graft size in living-related liver transplantations and assessed the usefulness of determining volume and dimensions of the graft and recipient's liver fossa by computed tomography to indicate the risk. Five of 150 living related liver transplantations had grafts that were too large, resulting in difficulty in primary abdominal closure or in sudden worsening of hemodynamics during primary closure. No significant difference existed in recipient age, sex, body weight, selection of the graft segment, hepatic vein reconstruction, recipient resected liver weight, graft volumetry value, the ratio of body weight of donor relative to recipient, and the percentage of graft weight relative to recipient body weight, between the groups with and without these problems. Mean +/- SEM of maximal dimensional ratio, defined as the maximum of the ratios of 3 dimensions of the graft relative to recipient liver fossa, were 2.36 +/- 0.64 for patients with grafts that were too large and 1.00 +/- 0.02 for the cases without size problems. The mean +/- SEM of liver fossa index, defined as the product of 3 dimensions of recipient liver fossa, were (25.03 +/- 7.18) x 10(4) mm3 and (127.54 +/- 5.07) x 10(4) mm3, respectively. These two indices clearly indicated the risk of problems due to large graft size, and will help to protect recipients and provide a basis for evaluating graft size in reductions.
我们研究了亲属活体肝移植中与移植肝体积过大相关问题的发生率和表现，并评估了通过计算机断层扫描确定移植肝和受体肝窝的体积及尺寸以提示风险的实用性。150例亲属活体肝移植中有5例移植肝体积过大，导致一期腹壁关闭困难或一期关闭时血流动力学突然恶化。有这些问题和没有这些问题的两组患者在受体年龄、性别、体重、移植肝段的选择、肝静脉重建、受体切除肝脏重量、移植肝体积测量值、供体与受体体重比以及移植肝重量占受体体重的百分比方面均无显著差异。最大维度比的平均值±标准误（最大维度比定义为移植肝的三个维度与受体肝窝的比值中的最大值），移植肝体积过大的患者为2.36±0.64，无尺寸问题的患者为1.00±0.02。肝窝指数的平均值±标准误（肝窝指数定义为受体肝窝三个维度的乘积）分别为(25.03±7.18)×10⁴mm³和(127.54±5.07)×10⁴mm³。这两个指标清楚地表明了移植肝体积过大导致问题的风险，并将有助于保护受体，为评估减体积移植肝的大小提供依据。
