Sling suspension of the liver in donor operation: a gradual tape-repositioning technique
Sling suspension of the liver in donor operation: a gradual tape-repositioning technique
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DOI：
10.1097/01.tp.0000080982.03297.a7
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发表时间：
2003-09
期刊：
影响因子：
6.2
通讯作者：
N. Kokudo;Y. Sugawara;H. Imamura;K. Sano;M. Makuuchi
中科院分区：
文献类型：
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作者：
N. Kokudo;Y. Sugawara;H. Imamura;K. Sano;M. Makuuchi
背景为了控制右肝切除术中更深实质平面的出血，Belghiti等人（J Am科尔外科杂志2001;193：109）提出了一种肝脏悬挂方法，使用悬带穿过下腔静脉（IVC）的前表面和肝实质之间。我们在供体手术中应用了这项技术，其中在分割移植物的供血或引流血管之前应进行肝实质横切。方法.在肝脏和IVC之间穿过一根带子后，将带子的下端拉到肝门后面，以有效牵引肝脏的背部。为了保留右肝移植物中重要的肝中静脉（MHV）分支，将胶带逐渐重新定位在静脉后面，并在分割静脉分支之前完成实质横断。移植物的充血在收获之前是最小的。在使用MHV的右半肝切除术中，将胶带切换到MHV后面以保留MHV。结果自2000年3月以来，该技术已用于71例连续供体手术，包括37例无MHV的右半肝切除术，8例MHV右半肝切除术，20例尾状叶左肝切除术和6例右外侧肝切除术。除1例（98.6%）外，所有供体的肝后捆扎均成功。没有与该手术相关的重大并发症。结论.这种新的方法，吊索悬挂的肝脏与渐进的磁带操作促进了悬浮作用，并在四种类型的供体手术是有用的。这些技术在大多数活体供体中是可行的，并被推荐为提高供体安全性和移植质量的基本程序。
Background. To control bleeding in the deeper parenchymal plane in right hepatectomy, Belghiti et al. (J Am Coll Surg 2001;193:109) proposed a liver-hanging maneuver using a sling passed between the anterior surface of the inferior vena cava (IVC) and the liver parenchyma. We applied this technique in donor operations in which a hepatic parenchymal transection should be performed before dividing the feeding or draining vessels for the graft. Methods. After passing a tape between the liver and the IVC, the lower tip of the tape is pulled up behind the hepatic hilum to enable effective traction of the dorsal part of the liver. To preserve significant middle hepatic vein (MHV) tributaries in right-liver graft, the tape is gradually repositioned behind the veins, and parenchymal transection is completed before dividing the venous tributaries. Congestion of the graft is minimal until harvest. In right hepatectomy with the MHV, the tape is switched behind the MHV to preserve the MHV. Results. Since March 2000, this technique has been used in 71 consecutive donor operations, including 37 right hepatectomies without the MHV, 8 right hepatectomies with the MHV, 20 left hepatectomies with the caudate lobe, and 6 right lateral sectorectomies. Taping behind the liver was successful in all but one donor (98.6%). There were no major complications related to this procedure. Conclusions. This new approach to the sling suspension of the liver with a gradual tape manipulation facilitated the suspending action and was useful in four types of donor operation. These techniques are feasible in most living donors and are recommended as basic procedures to enhance the safety of the donor and the quality of the graft.