Hepatic venous congestion in living donor liver transplantation: Preoperative quantitative prediction and follow-up using computed tomography
Hepatic venous congestion in living donor liver transplantation: Preoperative quantitative prediction and follow-up using computed tomography
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DOI：
10.1002/lt.20178
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发表时间：
2004-06-01
影响因子：
4.6
通讯作者：
Kim, MH
中科院分区：
文献类型：
--
作者：
Hwang, S;Lee, SG;Kim, MH
肝静脉淤血（HVC）在肝切除术前尚未被定量评估，其解决机制尚未得到充分分析。我们设计并验证了一种新的方法来预测HVC，其中HVC是从计算机断层扫描（CT）图像中肝中静脉（MHV）分支的勾画来估计的。将预测的HVC转移到20个活体供体的右肝叶，并使用纸标尺，并与实际观察到的肝实质横断和动脉夹闭后发生的HVC进行比较。CT随访HVC从出现到消退的演变过程。预测和观察到的HVC体积比例分别为右叶体积（RLV）的31.7 +/- 6.3%和31.3 +/- 9.4%（P= 0.74），导致RLV的预测误差为3.8 +/- 3.7%。我们观察了无MHV主干的供体和MHV重建的受体右叶HVC面积的变化。7天后，在12个供体残叶右叶中，RLV的33.5 +/- 7.7%的HVC变为RLV的28.4 +/- 5.3%的计算机断层扫描衰减异常（CTAA），在7例接受MHV重建的受体右叶移植物中，HVC为RLV的29.1 ± 11.5%，CTAA为RLV的9.3 ± 3.2%。在最初的7天内，供体残肝的HVC区域没有实质再生。总之，我们认为这种基于CT的HVC预测方法值得作为术前供体评估的一个不可避免的部分。供、受体右叶CTAA的变化提示MHV重建可有效缩小HVC面积。
Hepatic venous congestion (HVC) has not been assessed quantitatively prior to hepatectomy and its resolving mechanism has not been fully analyzed. We devised and verified a new method to predict HVC, in which HVC was estimated from delineation of middle hepatic vein (MHV) tributaries in computed tomography (CT) images. The predicted HVC was transferred to the right hepatic lobes of 20 living donors using a paper scale, and it was compared with the actual observed HVC that occurred after parenchymal transection and arterial clamping. The evolution of HVC from its emergence to resolution was followed up with CT. Volume proportions of the predicted and observed HVC were 31.7 +/- 6.3% and 31.3 +/- 9.4% of right lobe volume (RLV) (P=.74), respectively, which resulted in a prediction error of 3.8 +/- 3.7% of RLV. We observed the changes in the HVC area of the right lobes both in donors without MHV trunk and in recipients with MHV reconstruction. After 7 days, the HVC of 33.5 +/- 7.7% of RLV was changed to a computed tomography attenuation abnormality (CTAA) of 28.4 +/- 5.3% of RLV in 12 donor remnant right lobes, and the HVC of 29.1 +/- 11.5% of RLV was reduced to a CTAA of 9.3 +/- 3.2% of RLV in 7 recipient right lobe grafts with MHV reconstruction. There was no parenchymal regeneration of the HVC area in donor remnant livers during first 7 days. In conclusion, we believe that this CT-based method for HVC prediction deserves to be applied as an inevitable part of preoperative donor evaluation. The changes in CTAA observed in the right lobes of donors and recipients indicate that MHV reconstruction can effectively decrease the HVC area.