CAJ | 학술논문

目的探讨不含肝中静脉(middle hepatic vein,MHV)的成人间右半肝活体肝移植(living donor liver transplantation,LDLT)静脉流出道重建技术的改进方法.方法通过长征医院器官移植研究所2007年6月至2008年1月完成的11例次成人间不含肝中静脉的右半肝活体肝移植病例的回顾性分析,对成人间不含肝中静脉的右半肝活体肝移植静脉流出道重建技术的改进进行总结.主要技术改进包括:采用供肝右肝静脉、受体腔静脉联合扩大成形吻合技术重建流出道;采用在4℃UW液中保存7 d以内的尸体同种异体静脉移植血管重建供肝Ⅴ、Ⅷ段肝静脉粗大属支以及右肝下静脉.结果 11例次成人间不含肝中静脉右半肝活体肝移植中10例次采用了右肝静脉、腔静脉联合扩大成形吻合技术;利用尸体同种异体静脉移植血管架桥重建肝Ⅴ、Ⅷ段肝静脉以及右肝下静脉流出道的例数占同期实施的成人间活体肝移植总例数的81.8%(9/11),其中架桥重建1支肝静脉7例,架桥重建2支肝静脉1例,架桥重建3支肝静脉1例,11例病人中,1例病人术后14 d死于肾功能衰竭和肺部感染,超声检查血流通畅,未发现架桥静脉血栓,余10例病人术后随访9～15个月,右肝静脉均通畅,未发现静脉血栓,架桥肝静脉累计通畅率为:1个月100%(11/11)、3个月72.7%(8/11)、6个月54.5%(6/11)和9个月36.5%(4/11),移植肝脏再生均衡,右肝端面Ⅴ或Ⅷ段无明显充血和肝萎缩坏死,肝功能正常.超声检查未发现血栓,血流通畅,移植肝脏再生均衡,右肝端面Ⅴ或Ⅷ段无明显充血和肝萎缩坏死,肝功能正常.结论采用右肝静脉、腔静脉联合扩大成形吻合技术和在4℃UW液中保存7 d以内的尸体同种异体静脉移植血管重建肝Ⅴ、Ⅷ段肝静脉粗大属支以及右肝下静脉是一种简单、安全和有效的成人间不含肝中静脉右半肝活体肝移植肝静脉重建方法.
목적 탐토불함간중정맥(middle hepatic vein,MHV)적성인간우반간활체간이식(living donor liver transplantation,LDLT)정맥류출도중건기술적개진방법.방법 통과장정의원기관이식연구소2007년6월지2008년1월완성적11례차성인간불함간중정맥적우반간활체간이식병례적회고성분석,대성인간불함간중정맥적우반간활체간이식정맥류출도중건기술적개진진행총결.주요기술개진포괄:채용공간우간정맥、수체강정맥연합확대성형문합기술중건류출도;채용재4℃UW액중보존7 d이내적시체동충이체정맥이식혈관중건공간Ⅴ、Ⅷ단간정맥조대속지이급우간하정맥.결과 11례차성인간불함간중정맥우반간활체간이식중10례차채용료우간정맥、강정맥연합확대성형문합기술;이용시체동충이체정맥이식혈관가교중건간Ⅴ、Ⅷ단간정맥이급우간하정맥류출도적례수점동기실시적성인간활체간이식총례수적81.8%(9/11),기중가교중건1지간정맥7례,가교중건2지간정맥1례,가교중건3지간정맥1례,11례병인중,1례병인술후14 d사우신공능쇠갈화폐부감염,초성검사혈류통창,미발현가교정맥혈전,여10례병인술후수방9～15개월,우간정맥균통창,미발현정맥혈전,가교간정맥루계통창솔위:1개월100%(11/11)、3개월72.7%(8/11)、6개월54.5%(6/11)화9개월36.5%(4/11),이식간장재생균형,우간단면Ⅴ혹Ⅷ단무명현충혈화간위축배사,간공능정상.초성검사미발현혈전,혈류통창,이식간장재생균형,우간단면Ⅴ혹Ⅷ단무명현충혈화간위축배사,간공능정상.결론 채용우간정맥、강정맥연합확대성형문합기술화재4℃UW액중보존7 d이내적시체동충이체정맥이식혈관중건간Ⅴ、Ⅷ단간정맥조대속지이급우간하정맥시일충간단、안전화유효적성인간불함간중정맥우반간활체간이식간정맥중건방법.
Objective To investigate some improvements in the surgical techniques of adult-to-adult living donor liver transplantation( A-A LDLT) without the middle hepatic vein(MHV) for hepat-ic vein reconstruction. Methods The retrospective analysis was made on the clinical data of 11 recipi-ents who underwent the operation in A-A LDLT including the hepatic vein reconstructed in right liver lobe without MHV from June 2007 to January 2008. The key techniques included reconstructing out-flow of graft on shaping the tips of vena cava and right hepatic veins, cadaveric vein allografts stored in 4℃ UW solution within 7d being used for significant-sized hepatic vein reconstruction such as tributa-ries of the middle hepatic vein from V5, V8 and right inferior hepatic vein. Results 10 cases success-fully underwent reconstruction of outflow of graft on shaping the tips of vena cava and right hepatic veins and the outflow reconstruction ratio of V5, V8 and right inferior hepatic vein was 81. 8% (9/11), 7 one-vein reconstruction, 1 two-vein reconstruction and 1 three-vein reconstruction. 1 recipient died of renal failure and pulmonary infection 14 days after operation without venous outflow obstruc-tion. Doppler ultrasonography showed no thrombosis and the blood flowed smoothly in the right he-patic vein of other 8 recipients during the 9th to 15th mouth of follow-up. The cumulative patency rates of these 8 survivals for interposition vein grafts were 100% (11/11), 72. 7 %(8/11), 54. 5%(6/11) and 36. 5%(4/11) in 1, 3, 6 and 9 mouths, respectively. The regeneration of paramedian sectors was equivalent. Conclusion Shaping the tips of vena cava and right hepatic veins and using cadaveric vein allografts in adult-to-adult right lobe living donor liver transplantation for hepatic vein reconstruc-tion are both safe,simple and effective methods.This approach can be recommended.