A novel technique for collateral interruption to maximize portal venous flow in pediatric liver transplantation
A novel technique for collateral interruption to maximize portal venous flow in pediatric liver transplantation
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一种新颖的侧支阻断技术，可最大限度地提高小儿肝移植中的门静脉流量
DOI：
10.1002/lt.25016
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发表时间：
2018
影响因子：
4.6
通讯作者：
Kasahara Mureo
中科院分区：
文献类型：
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作者：
Sakamoto Seisuke;Sasaki Kengo;Kitajima Toshihiro;Hirata Yoshihiro;Narumoto Soichi;Kazemi Kourosh;Fukuda Akinari;Miyazaki Osamu;Nosaka Shunsuke;Kasahara Mureo
门静脉重建是小儿肝移植成功的关键。胆道闭锁（BA）常导致自体PV硬化或发育不良，门静脉血流量（PVF）可能减少，而侧支血管发育并引起PVF进一步减少。肺静脉循环中的这种负螺旋可能使LT时的肺静脉重建复杂化。在先前的研究中报告了几种技术改进，包括静脉移植物插入和纵向静脉成形术。(1)然而，除了PV重建技术，侧支阻断和足够的PVF是影响初始移植物功能的关键问题。截至2016年4月底，我们在389例受者中进行了403例LT（活体肝移植[LDLT]，n 5 379;死亡供体LT，n 5 20;多米诺LT，n 5 4）。23例（5.7%）患者发生肺静脉并发症，包括4例（1.0%）肺静脉血栓和19例（4.7%）肺静脉狭窄。值得注意的是，18例（4.5%）患者因术中肺静脉血栓形成需要再次吻合，发生在初次肺静脉重建后。术中肺静脉血栓形成可能是由于肺静脉血流不足伴侧支循环不完全中断或肺静脉重建技术决策不当，尤其是在未进行任何技术修改的情况下使用自体肺静脉。
Portal vein (PV) reconstruction is a key component for success in pediatric liver transplantation (LT). Biliary atresia (BA) often causes the native PV to become sclerotic or hypoplastic, and the portal venous flow (PVF) may decrease, whereas the collateral vessels develop and provoke a further decrease in the PVF. This negative spiral in PV circulation can complicate PV reconstruction at the time of LT. There have been several technical refinements reported in previous studies, including vein graft interposition and longitudinal venoplasty.(1) However, aside from the techniques of PV reconstruction, collateral interruption and sufficient PVF are crucial issues that can affect the initial graft function.At the end of April 2016, we had performed 403 LTs in 389 recipients (living donor liver transplantation [LDLT], n 5 379; deceased donor LT, n 5 20; domino LT, n 5 4). PV complications occurred after LT in 23 (5.7%) patients, including PV thrombus in 4 (1.0%) and PV stricture in 19 (4.7%). Notably, 18 (4.5%) patients required reanastomosis due to intraoperative PV thrombosis, which occurred after primary PV reconstruction. Intraoperative PV thrombosis might occur due to insufficient PVF with incomplete interruption of the collaterals or inappropriate decision making with regard to the technique of PV reconstruction, especially the use of the sclerotic native PV without any technical modifications.