Outflow reconstruction in right hepatic live donor liver transplantation.
Outflow reconstruction in right hepatic live donor liver transplantation.
复制标题
右肝活体肝移植中的流出道重建。
作者：
M. Kinkhabwala;J. Guarrera;Richard Leno;Robert S. Brown;J. Prowda;S. Kapur;J. Emond
背景
不恒定的静脉解剖结构增加了右肝活体肝移植（RH-LDT）中流出道并发症的风险，但目前还没有达成共识，以指导静脉流出道的最佳重建。
方法
我们回顾性分析了在1998年4月至2002年7月间进行的48例RH-LDT中，采用灵活的前副静脉入路进行的外科静脉重建。
结果
精算受体移植物和患者存活率分别为79%和85%。74%的患者行单肝静脉吻合。12例患者接受了20条副静脉的重建，包括7条后段静脉和13条前段静脉。前静脉重建技术包括与肝中静脉端端吻合、间置管道、静脉成形术或多种技术的组合。仅1例患者（2%）发生了与静脉吻合相关的记录并发症，没有患者记录到主RHV或重建副静脉的静脉血栓形成。单静脉重建与多静脉重建的结局无差异。在3例无解剖静脉吻合并发症的患者中观察到前内侧充血，但该发现的临床意义尚不清楚。
结论
尽管右肝移植物的节段性静脉引流和前内侧充血倾向存在差异，但RH-LDT可以在无流出道梗阻的情况下进行，并密切关注广泛的RHV吻合。此外，前副静脉重建可保留用于边缘大小或质量的移植物，其中早期术后静脉充血可能损害早期移植物功能。常规扩大肝切除术合并MHV与移植物是不必要的。
BACKGROUND
Inconstant venous anatomy increases the risk of outflow complications in right hepatic live donor liver transplantation (RH-LDT), but no consensus has emerged guiding optimal reconstruction for venous outflow.
METHODS
We retrospectively analyzed surgical venous reconstruction using a flexible approach to anterior accessory veins in 48 RH-LDTs performed between April, 1998 and July, 2002.
RESULTS
Actuarial recipient graft and patient survival was 79% and 85%, respectively. Single hepatic venous anastomosis was performed in 74% of the patients. Twelve patients underwent reconstruction of 20 accessory veins, including 7 posterior segment veins and 13 anterior segment veins. Anterior vein reconstruction techniques included end-to-end anastomosis to the middle hepatic vein, interposition conduit, venoplasty, or a combination of techniques. Documented complications related to the venous anastomosis occurred in only 1 patient (2%), with no patient having a documented venous thrombosis of either the main RHV or a reconstructed accessory vein. There were no differences in outcome based on single versus multiple venous reconstruction. Anteromedial congestion was noted in 3 patients in the absence of anatomic venous anastomotic complication, but the clinical significance of this finding is unclear.
CONCLUSIONS
Despite variations in segmental venous drainage and a propensity for anteromedial congestion in right hepatic grafts, RH-LDT can be performed without outflow obstruction with close attention to a wide RHV anastomosis. In addition, anterior accessory vein reconstruction can be reserved for grafts of marginal size or quality where early postoperative venous congestion may impair early graft function. Routine extended hepatectomy incorporating the MHV with the graft is unnecessary.