应用尸体静脉移植物重建成人右半肝活体肝移植肝静脉

Cadaveric vein allografts in reconstruction of hepatic vein in adult-to-adult right lobe living donor liver transplantation

目的:探讨尸体静脉移植物在成人间右半肝活体肝移植肝静脉重建中的应用价值。方法:对我院器官移植研究所2007年6月至2008年1月收治的9例成人间右半肝活体肝移植病例,采用在4℃UW液中保存7d以内的尸体静脉移植物重建供肝Ⅴ、Ⅷ段肝静脉粗大属支以及右肝下静脉,回顾分析相关资料,总结处理经验。结果:利用尸体静脉移植物重建肝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的81.8%(9/11),其中架桥重建1支肝静脉6例,架桥重建2支肝静脉2例,架桥重建3支肝静脉1例。9例患者中,1例患者术后14d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8例患者术后随访9～15个月,架桥肝静脉累计通畅率为: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。结论:采用在4℃UW液中保存7d以内的尸体静脉移植物重建肝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右半肝活体肝移植肝静脉重建方法。

Objective：To explore the value of cadaveric vein allografts in hepatic vein reconstruction in adult-to-adult living donor liver transplantation （LDLT）. Methods： The clinical data of 9 recipients, who underwent LDLT （including the hepatic vein reconstruction） in the right liver lobe without middle hepatic vein （MHV） from June 2007 to January 2008, were retrospectively analyzed. The cadaveric vein allografts were stored in 4℃ UW solution within seven days and were used for construction of large hepatic veins such as： tributaries of the middle hepatic vein from Ⅴ , Ⅷ and right inferior hepatic vein. Results： Cadaveric interposition vein allografts were used for venous reconstruction in 9 （81. 8%） of 11 cases receiving a modified right liver graft, 6 cases receiving one-vein reconstruction,2 cases receiving two-vein reconstruction and 1 case receiving three-vein reconstruction. Only 1 recipient died of renal failure and severe pulmonary infection on day 14 after transplantation without any hemiliver venous outflow obstruction. Doppler ultrasound showed no thrombosis and the blood flowed smoothly in the other 7 recipients during the 9 to 15 months follow-up period. The cumulative patency rates of the 8 survivals for interposition vein grafts were 72. 7% （8/11）,54. 5% （6/11）, and 36. 5% （4/11） at a,6, and 9 months, respectively. The regeneration of paramedian sectors was equivalent. Conclusion： Cadaveric vein allograft is safe, simple, and effective in adult-to adult right lobe living donor liver transplantation for hepatic vein reconstruction.