Technical challenges of hepatic venous outflow reconstruction in right lobe adult living donor liver transplantation
Technical challenges of hepatic venous outflow reconstruction in right lobe adult living donor liver transplantation
复制标题
右叶成人活体肝移植肝静脉流出道重建的技术挑战
作者：
R. Ghobrial;C. Hsieh;S. Lerner;S. Winters;N. Nissen;S. Dawson;F. Amersi;Pauline W. Chen;D. Farmer;H. Yersiz;R. Busuttil
通过在肝中静脉（MHV）右侧横断肝脏获得由肝右静脉（RHV）引流的右叶移植物。有时，会遇到一个小的RHV，仅引流右叶的一部分，主要流出由MHV实现。如果在进行右叶肝移植时没有识别出这种变异，并且仅使用RHV进行重建，则会发生静脉流出道阻塞，随后发生移植物充血，最终导致移植物衰竭。此外，保留主MHV及其左叶分支引流对于避免供体中剩余节段4的流出阻塞至关重要。我们报告了4例变异型小RHV和大MHV分支，不仅引流第5和第8段，而且引流第6和第7段。这些变异同时与也需要重建的大口径下RHV相关。用于诊断这种解剖变异的方法和重建技术在捐助者和接受者的描述。
A right lobe graft that is drained by the right hepatic vein (RHV) is obtained by transecting the liver on the right side of the middle hepatic vein (MHV). On occasion, a small RHV that only drains a portion of the right lobe, with the predominant outflow achieved by the MHV, is encountered. If such variation is not recognized while performing right lobe liver transplantation and the RHV only is used for reconstruction, venous outflow obstruction with subsequent graft congestion and eventual graft failure will occur. Additionally, preservation of the main MHV and its branch drainage of the left lobe is crucial to avoid outflow blockage to the remaining segment 4 in the donor. We report 4 cases showing a variant type of small RHV and large MHV branch that drain not only segments 5 and 8, but also segments 6 and 7. These variations were simultaneously associated with a large‐caliber inferior RHV that also required reconstruction. The methods used to diagnose such anatomic variations and the techniques for reconstruction in the donor and recipient are described.