Technical considerations of living donor hepatectomy of segment 2 grafts for infants.
Technical considerations of living donor hepatectomy of segment 2 grafts for infants.
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DOI：
10.1016/j.surg.2014.05.003
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发表时间：
2014-11
期刊：
影响因子：
3.8
通讯作者：
S. Sakamoto;H. Kanazawa;T. Shigeta;H. Uchida;K. Sasaki;Ikumi Hamano;A. Fukuda;S. Nosaka;H. Egawa;M. Kasahara
中科院分区：
文献类型：
--
作者：
S. Sakamoto;H. Kanazawa;T. Shigeta;H. Uchida;K. Sasaki;Ikumi Hamano;A. Fukuda;S. Nosaka;H. Egawa;M. Kasahara
背景选择合适的移植物以缓解与大体积移植物相关的问题是确保较小儿童肝移植成功的关键。减少左外侧段(LLS)移植是为了克服这一问题。方法5例婴儿行活体供肝移植(LDLT)，移植段为2。在术前评估中，以供肝重量比(GRWR)和供体LLS厚度比作为移植大小匹配的参考指标，并使用计算机生成的供肝三维模型分析肝内血管。在供体手术中，首先显露供血至节段3的相应门静脉分支，然后进行实质横断术。结果3例选择节段2，2例选择节段2。移植物复位率为46.6±8.2%，GRWR由5.33±2.09%降至2.70±0.82%。在移植物复位后，实际移植物厚度减少了大约一半。所有受者均行一期关腹手术。供者和受者均未发生手术并发症。结论2节段移植物在儿童原位肝移植中是一种有价值的移植物类型选择。使用3D计算机生成的供体肝脏模型进行精确的计划和细致的手术程序是获得可行的移植物所必需的。
BackgroundThe selection of an adequate graft to mitigate the problems associated with a large-for-size graft is essential to ensure the success of liver transplantation for smaller children. Reduced left lateral segment (LLS) grafts have been introduced to overcome this issue.MethodsFive infants underwent living donor liver transplantation (LDLT) with segment 2 grafts. In the preoperative assessment, the graft-to-recipient weight ratio (GRWR) and the ratio of the thickness of the donor LLS were used as a reference index for graft size matching, and a 3-dimensional (3D) computer-generated model of the donor liver was used for the analysis of the intrahepatic vasculature. During the donor operation, the relevant portal vein branches feeding to the reduced part of segment 3 were first exposed and divided, and then the parenchymal transection was performed.ResultsSegment 2 grafts were selected in 3 cases and reduced segment 2 grafts were selected in the other 2 cases. The graft reduction was achieved with 46.6 ± 8.2% of the actual LLS, and thus the GRWR was reduced from 5.33 ± 2.09% to 2.70 ± 0.82%. The actual graft thickness was reduced by approximately half after the graft reduction. Primary abdominal closure was performed in all of the recipients. No surgical complications occurred in any of the donors or recipients.ConclusionA segment 2 graft could be a valuable option for graft type selection in LDLT for smaller children. Precise planning using a 3D computer-generated model of the donor liver and meticulous operative procedures are necessary to obtain a viable graft.