成人间体外劈离式肝移植中肝静脉分配方式的临床观察

A clinical report about distributions of hepatic veins in ex vivo adult to adult split liver transplantation

目的分析成人间劈离式肝移植中肝静脉不同分配方式的利弊,探讨合理的临床分配方案。方法回顾2007年1月至2011年10月间天津市第一中心医院完成的12例成人间劈离式肝移植病例的肝静脉分配及重建方式,观察患者术后的肝静脉血管并发症及相关预后。结果 12例患者中,使用右半肝的6例患者采取了4种静脉分配和重建方式:肝右+肝中+腔静脉1例;肝右+5、8段静脉重建+腔静脉2例;肝右+5、8段静脉重建2例;肝右+1/2肝中+腔静脉1例。相应地,另外6例左半肝移植物亦得到4种肝静脉分配和重建方式:肝左+4段静脉重建1例;肝左+肝中静脉2例;肝左+肝中+腔静脉2例;肝左+1/2肝中静脉1例。术后1例左半肝采用肝左+4段静脉重建,患者因4段重建血管阻塞导致小肝综合征,最终死亡,其余11例患者未出现肝静脉相关并发症。结论成人间劈离式肝移植的肝静脉分配和重建可有多种方式,在临床操作中应在满足移植物功能性肝体积足够的前提下,结合患者病情和外科操作的需要制定合理的个体化方案。

Objective To investigate clinical respective effects on different distribution of hepatic veins in adult to adult split liver transplantation（SLT） ex vivo.Methods A retrospective analysis was conducted on 12 adult to adult split liver transplantations performed at Tianjin First Centra1 Hospital from Jan 2007 to Oct 2011.The analysis was focused on the distribution and reconstruction of hepatic veins,and monitoring the vascular complications and patient＇s prognosis.Results There were four types about distribution of hepatic vein in 6 right hemi-liver grafts： one graft got RHV（right hepatic vein）＋MHV（middle hepatic vein）＋Vena cava;two cases was with RHV＋5,8 vein reconstruction ＋Vena cava;another 2 grafts obtained RHV＋5,8 segmental vein reconstruction;the last one was consist of RHV＋ hemi-MHV ＋Vena cava.For split liver 6 corresponding left grafts had 4 variations as： LHV（left hepatic vein）＋vein of 4 segments reconstructed;LHV＋MHV;LHV＋MHV＋Vena cava;LHV＋ hemi-MHV.One recipient with LHV＋vein of 4 segments reconstructed left liver graft occurred small for size syndrome for occlusion of reconstructed 4 segmental veins and eventually died.Other recipients had no complications related with hepatic vein.Conclusions Multiple methods exist when we face to distribution and reconstruction of hepatic vein in adult to adult split liver transplantation.Before making a decision on how to split hepatic vein in clinical procedure,it is necessary to prove the functional graft volume enough first,then considering patient＇s conditions and feasibility of surgical procedures.