Successful hepatic vein reconstruction in 42 consecutive living related liver transplantations.
Successful hepatic vein reconstruction in 42 consecutive living related liver transplantations.
复制标题
连续42例活体肝移植成功完成肝静脉重建。
DOI：
10.1067/msy.2000.106783
复制
发表时间：
2000
期刊：
影响因子：
3.8
通讯作者：
H. Kawarasaki
中科院分区：
文献类型：
--
作者：
K. Kubota;M. Makuuchi;T. Takayama;Y. Harihara;M. Watanabe;K. Sano;K. Hasegawa;H. Kawarasaki
背景
在活体肝移植（LRLT）中，通过端端吻合重建肝静脉（HV）已被报道与急性或晚期流出道阻滞相关。
方法
我们回顾了1996年1月至1998年9月间接受LRLT的42例患者。
结果
在从左外段切除术或扩大的外段切除术获得的26个供体移植物中有7个（27%）和从左叶切除术获得的16个移植物中有9个（56%）需要静脉成形术。在其余26个移植物中，获得了1个开口的左HV。除了Arantius管的分离，16例患者的左膈下静脉常规分离，这有助于将静脉成形术率从46%降至25%（P = 0.1704）。所有42例患者均通过端端吻合成功重建HV。受体HV直径与移植物HV直径的中位比值为1.2（范围，0.8-2.1）。在多普勒超声显示相应血管中有足够血流的部位，使用镰状韧带和圆韧带将移植物固定在腹壁上。3例患者发生迟发性HV梗阻，需要通过静脉途径或经鞘途径进行球囊扩张：1例患者在术后第232天接受了新肝脏，1例患者死于败血症，无流出道阻塞，最后1例患者情况良好。
结论
在LRLT中，分离Arantius管和左膈下静脉，然后广泛夹闭总干有助于获得1孔HV。这有利于移植物的HV与受体的HV的吻合，并且通过使用镰状韧带和圆形韧带固定移植物防止移植物旋转和随后的急性流出道阻塞。
BACKGROUND
In living related liver transplantation (LRLT), reconstruction of the hepatic vein (HV) by end-to-end anastomosis has been reported to be associated with acute or late outflow block.
METHODS
We reviewed 42 patients who underwent LRLT from January 1996 to September 1998.
RESULTS
In 7 (27%) of the 26 donor grafts obtained from left lateral segmentectomy or extended lateral segmentectomy and in 9 (56%) of the 16 grafts obtained from left lobectomy, venoplasty was required. In the remaining 26 grafts, 1-orifice left HV was obtained. In addition to the division of the duct of Arantius, the left inferior phrenic vein was divided routinely in 16 patients, which contributed to reducing the venoplasty rate from 46% to 25% (P =.1704). In all 42 patients, HV was reconstructed successfully by end-to-end anastomosis. The median ratio of the diameter of the recipient's HV to that of the graft's HV was 1.2 (range, 0.8-2.1). The grafts were fixed to the abdominal wall by using the falciform and round ligaments at a site where Doppler ultrasound showed sufficient flow in the respective vessels. Three patients developed late-onset HV obstruction and required balloon dilatation either by means of a venous route or a transhepatic route: 1 patient received a new liver on the 232nd postoperative day, 1 patient died of sepsis without outflow block, and the last patient is doing well.
CONCLUSIONS
In LRLT, the division of the duct of Arantius and the left inferior phrenic vein followed by extensive clamping of the common trunk contributed to obtaining a 1-orifice HV. This facilitates anastomosis of the HVs of the grafts to the recipients' HVs, and fixation of the grafts by using the falciform and round ligaments prevents rotation of the grafts and subsequent acute outflow block.
影响因子：
9
作者：
TANAKA, K;UEMOTO, S;OZAWA, K
通讯作者：
OZAWA, K