Meso‐systemic shunt for middle hepatic vein reconstruction in right lobe living donor liver transplantation
Meso‐systemic shunt for middle hepatic vein reconstruction in right lobe living donor liver transplantation
复制标题
右叶活体肝移植中肝中静脉重建的细系统分流术
DOI：
10.1111/j.1432-2277.2007.00566.x
复制
发表时间：
2007
影响因子：
3.1
通讯作者：
Y. Maehara
中科院分区：
文献类型：
--
作者：
T. Ikegami;Y. Soejima;A. Taketomi;H. Kayashima;Y. Maehara
在许多情况下，在器官移植过程中，特别是在肝脏移植中，需要使用血管移植物。在尸体肝移植中，血管移植物通常从髂血管获得[1]。在活体肝移植（LDLT）中，从活体供体获得这种移植物在伦理上是不合适的，因此在获得合适的血管移植物方面存在各种困难[2]。然而，随着成人至成人右叶LDLT的广泛应用，对血管移植物的需求大大增加，其中前段的引流静脉可能需要重建。患者为57岁男性，患有继发于丙型肝炎的终末期肝病伴肝细胞癌。捐赠者是他30岁的健康儿子。移植物有一条来自第5段的大引流静脉，占引流面积的204 ml（移植物体积的28%）（图1a）。受者的CT扫描显示门静脉严重狭窄，大口径的系膜-体循环分流流入囊周静脉丛作为侧支分流（图1b）。在全肝切除术前获得一段长10 cm、直径18 mm的系膜-体循环分流。在后台使用7-0 Prolene（Ethicone Inc，萨默维尔，NJ，USA）连续缝线，以端对端的方式将8 mm口径的移植物V5缝合到所获得的系膜-系统分流移植物上。全肝切除术后，将颈静脉移植物与受体的脾系膜静脉交界处缝合。移植肝右静脉与受体肝右静脉尾侧吻合，肝右下静脉与腔静脉吻合。使用6-0 PDS-II（Ethicone Inc）连续缝线完成门静脉移植物和从左颈静脉获得的间置移植物之间的门静脉吻合。顺利再灌注后，用6-0 Prolene TM连续缝线将来自V5的间置系膜-体循环分流移植物的末端缝合到受体的肝中静脉（MHV），然后灌注（图2）。间置移植物迅速充盈，并提供了第5节段的良好流出。术中术后-
There are many situations where it is necessary to use vascular grafts during organ transplantations, especially in liver transplantations. In cadaveric liver transplantation, vascular grafts are usually obtained from the iliac vessels [1]. In living donor liver transplantation (LDLT), it is not ethically appropriate to procure such a graft from living donors, thus resulting in various difficulties in obtaining appropriate vascular grafts [2]. However, the need for vascular grafts has tremendously increased with the wider applications of adult-to-adult right lobe LDLTs, in which the drainage veins from the anterior segment may need to be reconstructed. The patient was a 57-year-old male with end-stage liver disease secondary to hepatitis C with hepatocellular carcinoma. The donor was his 30-year-old healthy son. The graft had a large drainage vein from Segment-5 accounting for 204 ml (28% of the graft volume) of the drainage area (Fig. 1a). The CT scan of the recipient showed severe portal vein stenosis with a large-caliber meso-systemic shunt draining into the peri-cystic venous plexus as a collateral shunt (Fig. 1b). A segment of the meso-systemic shunt, 10 cm in length and 18 mm in diameter, was obtained before the total hepatectomy. The V5 of the graft, 8 mm in caliber, was anastomosed in an end-to-end fashion to the procured meso-systemic shunt graft using 7–0 Prolene (Ethicone Inc, Somerville, NJ, USA) continuous sutures on the back-table. After total hepatectomy, the jugular vein graft was anastomosed to the recipient’s meso-splenic venous junction. The right hepatic vein of the graft was anastomosed to the recipient’s right hepatic vein with caudal caval spatulation, followed by the anastomosis between the right inferior hepatic vein and the vena cava. The portal vein anastomosis between the graft portal vein and the interposition graft obtained from the left jugular vein was completed using 6–0 PDS-II (Ethicone Inc) continuous sutures. After smooth reperfusion, the end of the interposed meso-systemic shunt graft from the V5 was anastomosed to the recipient’s middle hepatic vein (MHV) with 6–0 Prolene TM continuous sutures, followed by perfusion (Fig. 2). The interposition graft filled promptly and provided a good outflow from Segment 5. The intraand postopera-
影响因子：
3.8
作者：
Y. Soejima;M. Shimada;T. Suehiro;T. Yoshizumi;K. Kishikawa;Y. Maehara
通讯作者：
Y. Soejima;M. Shimada;T. Suehiro;T. Yoshizumi;K. Kishikawa;Y. Maehara
影响因子：
9
作者：
TANAKA, K;UEMOTO, S;OZAWA, K
通讯作者：
OZAWA, K