冷冻保存髂静脉用于活体右半肝移植肝中静脉重建

CRYOPRESERVED ILIAC VEIN FOR RECONSTRUCTION OF MIDDLE HEPATIC VEIN IN LIVING DONOR RIGHT LIVER TRANSPLANTATION

目的总结活体肝移植术中采用冷冻保存的髂静脉进行受者肝中静脉重建的方法和经验。方法 2006年7月-2009年6月,共完成85例活体肝移植,37例为不带肝中静脉的右半肝移植,其中30例采用冷冻保存的髂静脉重建受者肝中静脉。男27例,女3例;年龄10～57岁,中位年龄44岁。病因:肝细胞癌11例,肝硬化10例,肝豆状核变形2例,原发性胆汁性肝硬化2例,胆管细胞癌1例,肝母细胞瘤1例,先天性肝纤维化1例,重症肝炎1例,先天性胆道闭锁1例。尸体髂静脉取出后置于0～4℃混合抗生素生理盐水中,运送至手术室,经修剪后置于盛有RMPI 1640、20%DMSO、10%小牛血清溶液的无菌袋中,—70℃冻存备用。术中采用冷冻保存的髂静脉重建受者肝中静脉。术后定期复查,出院后规律随访3个月,超声及强化CT检查血管通畅性。结果 30例患者共使用30条髂静脉。从血管获取、冷冻保存到融解使用时间3～44 d,平均14 d。术中血管吻合均获得成功,经过冷冻保存的血管质地及弹性适于吻合,未出现撕裂及缝合针孔严重渗血等情况。其中6例重建Ⅴ段肝静脉,3例重建Ⅷ段肝静脉,21例同时重建Ⅴ、Ⅷ段肝静脉。重建血管1周通畅率为93%,2周通畅率为90%,1个月通畅率为90%,3个月通畅率为67%。供者无严重并发症,受者总体预后良好,无小肝综合征发生。结论冷冻髂静脉是一种用于成人活体右半肝移植中肝中静脉重建的理想材料。

Objective To summarize the experience of living donor liver transplantation using cryopreserved iliac vein for middle hepatic vein reconstruction.Methods Between July 2006 and June 2009,right liver transplantation without middle hepatic vein was performed in 37 cases of 85 patients undergoing living donor liver transplantation;of 37 cases,30 received middle hepatic vein reconstruction using cryopreserved iliac vein.There were 27 males and 3 females,aged from 10 to 57 years（median,44 years）.Thirty cases included 11 hepatocellular carcinoma,10 hepatic cirrhosis,2 Wilson’ s disease,1 cholangiocarcinoma,1 hepatoblastoma,1 congenital hepatic fibrosis,1 chronic severe hepatitis,and 1 congenital biliary atresia.Iliac veins harvested from donors were put into 0-4℃ mixed antibiotics saline and transported to the operating room.The iliac veins were trimmed,placed into sterile bags（containing RMPI 1640 ＋ 20% DMSO ＋ 10% calf protein solution） and frozen at —70.In living donor liver transplantation process,the veins were melt and used for middle hepatic vein ℃ reconstruction.After operation,the patency of veins was monitored by regular Doppler ultrasound examination or enhanced CT for 3 months.Results In 30 patients,30 iliac veins were used.The average cryopreserve time was 14 days（range,3-44 days）.Anastomosis were all successful;after cryopreservation,the blood vessels texture and elasticity were fit for surgery.No easily tearing or severe suture bleeding was observed.In 30 patients,6 had segment V veins reconstruction;3 had segment VIII;and 21 had both segments V and VIII.The patency rate of reconstructed vessels was 93% at 1 week,90% at 2 weeks,90% at 1 month,and 67% at 3 months.No serious complication was observed in donors.The prognosis was good with no small-for-size syndrome.Conclusion Cryopreserved iliac vein is an ideal material for the right hepatic living donor liver transplantation in the reconstruction of middle hepatic vein.