Post-transplant changes of segment 4 after living related liver transplantation.
Post-transplant changes of segment 4 after living related liver transplantation.
复制标题
活体相关肝移植后第4段的移植后变化。
作者：
Y. F. Cheng;C. Chen;T. Haung;T. Lee;T. Y. Chen;Y. Chen;P. Liu;Y. Chiang;H. Eng;C. Wang;H. Cheung;B. Jawan;S. Goto
本研究的目的是评估活体相关肝移植（LRLT）后移植物内侧段的结果。在接受 LRLT 的 12 名儿科受者中，2 名接受了整个左肝移植，1 名接受了左侧肝段移植，9 名接受了延伸的左侧肝段移植。肝移植前和移植后6个月检查供体肝静脉，测量肝脏内侧段和左侧肝体积。还通过多普勒超声评估了内侧段移植物中门静脉的流速和方向。 LRLT 后 6 个月，所有受者的移植肝脏体积显着增加 9-120%。对于左侧节段，所有病例的体积均增加了 21% 至 245%。对于内侧段，在第 4 段肝内门静脉内检测到正常肝血流的 7 例病例中，发现体积增加了 5-48%。在 4 例中，延伸左侧肝移植物的部分内侧段移植物的体积从 33% 减少到 69%。这4例中，内侧段肝内门静脉还检测到慢流（n = 2）和离肝流（n = 1）。移植物肝静脉支流标测显示部分4段移植物静脉引流不足，这可能是部分4段移植物萎缩性改变的原因。总之，注意到左侧节段和内侧节段之间的再生率不同，左侧节段的再生率更高。内侧段的静脉引流是决定再生结果的首要考虑因素。当肝静脉引流不足时，就会发生萎缩性变化。因此，如果需要扩大左侧肝移植，必须保留部分内侧段相应的引流静脉。否则，整个左肝或左外侧段移植将是更好的选择。
The purpose of this study was to evaluate the outcome of the medial segment of the graft after living related liver transplantation (LRLT). Of the 12 pediatric recipients who underwent LRLT, 2 received whole left liver graft, 1 left lateral segment graft, and 9 extended left lateral segment grafts. The hepatic veins of the donor were reviewed and the volume of the medial segment and left lateral liver was measured before and 6 months after liver transplantation. The flow velocity and direction of the portal vein in the medial segment graft was also evaluated by Doppler ultrasound. The grafted livers of all recipients showed a substantial increase in volume of 9-120% 6 months after LRLT. For the left lateral segment, an increase in volume was found in all cases ranging from 21 to 245%. For the medial segment, volume increases of 5-48% were found in seven cases with normal hepatopetal flow detected inside the segment 4 intrahepatic portal vein. In four cases, the partial medial segment graft of the extended left lateral liver graft decreased in volume from 33 to 69%. Among these four cases, slow flow (n = 2) and hepatofugal flow (n = 1) were also detected in the intrahepatic portal vein of the medial segment. Mapping of the tributary of the hepatic veins of the graft revealed inadequate venous drainage of the partial segment 4 graft, which may be considered as the cause of the atrophic change of the partial segment 4 graft. In conclusion, different regenerative rates between the left lateral segment and the medial segment were noted, with a greater rate in the left lateral segment. The venous drainage of the medial segment is of primary concern in the determination of the outcome of the regeneration. Atrophic change occurs when inadequate hepatic venous drainage is encountered. Therefore, if an extended left lateral liver graft is required, the corresponding draining veins of the partial medial segment must be preserved. Otherwise, whole left liver or left lateral segment graft would be a better choice.