Techniques of reconstruction of hepatic veins in living-donor liver transplantation, especially for right hepatic vein and major short hepatic veins of right-lobe graft
Techniques of reconstruction of hepatic veins in living-donor liver transplantation, especially for right hepatic vein and major short hepatic veins of right-lobe graft
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DOI：
10.1007/s00534-005-1019-7
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发表时间：
2006-01-01
期刊：
影响因子：
--
通讯作者：
Lee, SG
中科院分区：
文献类型：
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作者：
Lee, SG
活体肝移植（LDLT）现在被广泛接受为急性和慢性终末期肝病成人患者的治疗选择。在早期，左叶是用于成人LDLT的主要肝移植物，以确保供体安全，特别是在东方国家。然而，左叶LDLT中移植物尺寸不足的频繁极端代表了受体中小尺寸移植物综合征的更大风险，这已经将注意力集中在活体供体的右叶移植上。右叶LDLT的主要关注点集中在其对供体的安全性以及在移植物中包括肝中静脉（MHV）以避免右眼前段充血的必要性。MHV为右眼前段进行重要的静脉引流，对于完美的移植物功能至关重要。在许多研究中广泛讨论了是否将MHV与肝移植物（扩展右叶移植物）一起取出或是否将其保留在供体中，并在肝移植物中重建MHV支流（改良右叶移植物）。然而，对于右叶移植物功能的完整性，移植肝的适当右肝静脉和主要短肝静脉（右肝中静脉和右肝下静脉[RHV]）引流可能与MHV流出引流同样重要。本文作者介绍了各种肝右静脉和主要肝短静脉的静脉成形术，以消除这些静脉的静脉流出道阻塞。
Living-donor liver transplantation (LDLT) is now widely accepted as a therapeutic option for adult patients with acute and chronic end-stage liver disease. In the early period, the left lobe was the major liver graft used in adult LDLT to ensure donor safety, especially in Eastern countries. However, the frequent extremes of graft-size insufficiency in left-lobe LDLT represented a greater risk of small-for-size graft syndrome in the recipient, which has focused attention on transplantation of the right lobe from a living donor. The major concern of right-lobe LDLT has focused on its safety for the donor and the necessity for including the middle hepatic vein (MHV) in the graft to avoid congestion of the right anterior segment. The MHV carries out important venous drainage for the right anterior segment and is essential for perfect graft function. The decision of whether to take the MHV with the liver graft (extended right lobe graft) or whether to retain it in the donor, with reconstruction of the MHV tributaries in the liver graft (modified right lobe graft) has been extensively discussed in numerous studies. However, adequate right hepatic vein and major short hepatic vein (middle and inferior right hepatic vein [RHV]) drainage of the liver graft is perhaps equally important as MHV outflow drainage for the integrity of right-lobe graft function. Herein, the author describes various techniques of venoplasty of the right hepatic vein (RHV) and the major short hepatic veins to obviate venous outflow obstruction in these veins.