Innovative techniques for and results of portal vein reconstruction in living-related liver transplantation.
Innovative techniques for and results of portal vein reconstruction in living-related liver transplantation.
复制标题
活体肝移植门静脉重建的创新技术及效果。
DOI：
10.1016/s0039-6060(99)70236-9
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发表时间：
1999
期刊：
影响因子：
3.8
通讯作者：
Koichi Tanaka
中科院分区：
文献类型：
--
作者：
I. Marwan;A. Fawzy;H. Egawa;Y. Inomata;S. Uemoto;K. Asonuma;T. Kiuchi;M. Hayashi;S. Fujita;Y. Ogura;Koichi Tanaka
研究背景门静脉重建是影响活体肝移植成功与否的关键因素。我们在这里描述了我们在 314 例亲属活体肝移植中进行门静脉重建的经验，使用新颖的手术方式使移植外科医生能够处理供体和受体门静脉之间的任何尺寸不匹配。方法门静脉重建分为 2 个主要组，不使用静脉移植物的吻合和使用静脉移植物的吻合。当受受体门静脉无狭窄且直径相同时，采用门静脉主干进行吻合。当直径失配最小时，分支补片吻合是可行的。当受者门静脉明显狭窄且移植物门静脉足够长时，切除狭窄主干，在移植物门静脉与受者门静脉汇合处建立吻合。当移植物门静脉较短时，插入静脉移植物。当移植静脉直径不足以进行介入技术时，静脉补片技术是首选。结果无静脉移植的吻合包括主干吻合（n = 156）、分支补片吻合（n = 39）和汇合吻合（n = 22）。静脉移植吻合采用插入技术 (n = 77) 和静脉补片技术 (n = 27)。移植物的来源主要来自母亲左卵巢静脉（70%）或父亲肠系膜下静脉（27%）。 16 名（5%）患者出现门静脉重建相关并发症：8 名患者出现门静脉血栓，7 名患者出现狭窄，1 名患者致命性破裂。除汇合吻合外，所有技术的并发症发生率相似。结论我们的创新技术应有助于克服小儿肝移植门静脉重建中的直径或长度不匹配问题。 （外科手术 1999；125：265-70。）
BackgroundPortal vein reconstruction is a crucial factor affecting the outcome of a successful living-related liver transplantation. We describe here our experience with portal vein reconstruction in 314 cases of living-related liver transplantation with use of novel surgical modalities to enable the transplant surgeons to deal with any size mismatch between the donor's and recipient's portal veins.MethodsPortal vein reconstruction was classified into 2 major groups, anastomosis without and with a vein graft. When there was no stenosis of the recipient portal vein and the diameter was the same, the portal trunk was used for anastomosis. When the diameter mismatch was minimal, branch patch anastomosis was feasible. When the recipient portal vein was significantly stenotic and the portal vein of the graft was long enough, we removed the stenotic trunk and constructed an anastomosis between the graft portal vein and the confluence of the recipient portal vein. When the graft portal vein was short, a vein graft was interposed. The vein patch technique was preferable when the diameter of the graft vein was not large enough for the interposition technique.ResultsAnastomosis without vein graft included trunk anastomosis (n = 156), branch patch anastomosis (n = 39), and confluence anastomosis (n = 22). Anastomosis with vein graft used the interposition technique (n = 77) and vein patch technique (n = 27). The origin of the grafts was mostly from the maternal left ovarian vein (70%) or the paternal inferior mesenteric vein (27%). Complications related to portal vein reconstruction occurred in 16 (5%) patients: portal vein thrombosis in 8, stenosis in 7, and fatal rupture in 1 patient. The incidence of complications was similar for all techniques except for confluence anastomosis.ConclusionOur innovative techniques should be helpful for overcoming diameter or length mismatches in portal vein reconstruction in pediatric liver transplantation. (Surgery 1999;125:265-70.)