活体右半供肝Ⅴ和Ⅷ段静脉回流的重建方法

Reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe （without middle hepatic vein） living donor liver transplantation

目的总结活体右半供肝移植中，不含肝中静脉的右半供肝Ⅴ、Ⅷ段静脉回流的重建方法。方法回顾性分析55例活体右半供肝移植中，不含肝中静脉的右半供肝Ⅴ、Ⅷ段静脉回流重建的临床资料。所有供者均通过了受者标准肝体积、供肝与受者体重比（GRWR）、供肝与受者标准肝体积比及供肝内血管解剖等指标的综合评估。供肝在切取、灌注及修整后，51例采用尸体髂静脉作为重建材料，其他4例分别采用受者的大隐静脉、曲张的脐静脉、肝内门静脉和肝静脉作为重建材料，以串联的方式重建供肝断面Ⅴ、Ⅷ段静脉回流。肝移植时，供肝肝右静脉与受者肝右静脉开口吻合，重建的Ⅴ、Ⅷ段静脉与受者肝中、肝左静脉汇合部吻合，供肝门静脉与受者门静脉右支或主干吻合。门静脉开放血流后依次重建肝动脉及胆道。术后对供、受者进行常规监测。结果1例受者术后发生流出道梗阻，术后第43天死亡；1例受者术后第7天出现不明原因的急性重型肝组织坏死，行尸体供肝肝移植后痊愈。其余53例受者恢复顺利，术后4周时腹部CT检查显示重建的移植肝Ⅴ、Ⅷ段静脉回流通畅。55例供者术后均恢复顺利，术后2周出院。结论不含肝中静脉的活体右半供肝Ⅴ、Ⅷ段静脉回流的重建在活体肝移植中是可行的，应选择合适的重建材料及手术方式。受者肝移植后临床效果良好。

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe （without middle hepatic vein） living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷhepatic veins with proper materials in right lobe （without middle hepatic vein） living donor liver transplantation is feasible, and the effect is satisfactory.