术中超声在活体肝移植供体手术中的应用

Intraoperative ultrasound applied in donor surgery of living donor liver transplantation

目的探讨术中超声在活体肝移植(LDLT)供体手术中的应用。方法2005年3月-2005年11月我院15例右半供肝活体肝脏移植,由术中超声在肝中静脉的右侧1cm处确立切右半肝切除线,并提示直径0.5cm以上的肝中静脉属支、肝短静脉和副右肝静脉。结果沿术中超声所确定的切肝界线成功切取移植物;术中超声提示的肝Ⅴ、Ⅷ段肝中静脉粗大属支以及肝下右静脉(IRHV)的类型及例数如下:V5(n=2)、V8(n=2)、V5和V8(n=1)、V5和IRHV(n=1)、V8和IRHV(n=1)。结论术中超声的引导在切除供体右肝时非常重要,可以明确切肝界线,提示较粗大的肝中静脉属支及第三肝门的血管,有利于这些静脉的重建,确保移植物有足够的静脉引流。

Objective To discuss the application of intraoperative ultrasound （IOUS） in the donor surgery of living donor liver transplantation （LDLT）. Methods Fifteen patients undergone LDLT during Mar 2005 to Nov 2005 were enrolled in the study. To mark a resection line of the right lobe which was running parallel about 1 cm to the right of middle hepatic vein with IOUS. Tributaries of middle hepatic vein or short hepatic veins or accessory right hepatic vein larger than 0.5 cm were identified by IOUS. Results Grafts were successfully resected according to the resection line. Types and numbers of tributaries of middle hepatic vein or short hepatic veins larger than 0.5 cm were listed below： V5 （n=2） ,V8 （n=2） ,V5 and V8 （n= 1）, V5 and inferior right hepatic vein （n = 1）, V8 and inferior right hepatic vein （n= 1）. Conclusion IOUS plays an important role in the donor surgery of LDLT, witch helps to delineate resection line and identify large tributaries of middle hepatic vein or short hepatic veins.