门静脉-下腔静脉吻合术预防活体肝移植术后小肝综合征3例报道

Anastomosis of portal vein and inferior vena cava in preventing small-for-size liver syndrome after living donor liver transplantation:three cases report

目的探讨门静脉-下腔静脉吻合术用于预防活体肝移植术后小肝综合征(small-for-size liver syndrome,SFSS)的效果。方法 3例活体肝移植均采用不含肝中静脉的右半肝作为移植物。术中发现实测移植物(肝)重量/受体的体质量(体重)的比值(graft to recipient weight ratio,GRWR)为0.58%、0.77%及0.71%,均<0.8%,符合小移植物的诊断。处理:首先吻合肝静脉流出道,其次吻合门静脉,将受体门静脉右支与移植肝门静脉右支端端吻合,将受体门静脉左支与下腔静脉行端侧吻合达到门腔分流的作用,之后按顺序吻合动脉和胆道。术中均未行脾静脉结扎或脾切除等处理。术后定期随访。结果 3例患者术后均未发生SFSS并顺利出院,出院时间分别为术后25d、34d及56d。移植肝功能逐步好转,术后1d门静脉流速理想。移植肝增长良好。门静脉-下腔静脉短路通畅时间:除1例通畅持续仅104d,其余2例持续通畅。结论 LDLT术中进行门静脉-下腔静脉吻合术可以及时有效预防小移植物背景下的SFSS,受体门静脉左支与下腔静脉行端侧吻合的分流技术安全可靠。

Objective To evaluate the effect of anastomosis of portal vein and inferior vena cava on preventing small-for-size liver syndrome （SFSS） after living donor liver transplantation. Methods The right lobe of the liver without middle hepatic vein as graft was used in three living donor liver transplantation reci- pients. The intraoperative actual graft to recipient weight ratios （GRWR） were 0. 58%, 0. 77% and 0. 71%, all less than 0. 8% respectively, which accorded to the diagnosis of small for size graft. Treatment： The anasto- mosis of the hepatic vein was firstly performed, then the anastomosis of portal vein was performed. The end-end anastomosis was performed in right branch of portal vein of recipient to the right branch of portal vein of graft. Thirdly the end-side anastomosis was performed in left branch of portal vein to inferior vena cava for shunt. Fourthly the anastomosis of the artery and the bile duct were performed in order. No splenectomy or splenic vein ligation was performed during the operation. The patients were followed up regularly. Results None of the 3 patients was developed SFSS and all of them discharged from hospital smoothly. The hospitalized time were re- spectively 34, 25 and 56 days after operation. The shunts were all unobstructed in the first day after operation, and the liver function of the three patients recovered uneventfully. The graft liver developed well. Except shunt of case 3 lasted for only 104 days after operation, that of the other two cases were still open now. Conclusions In living donor liver transplantation, anastomosis of portal vein and inferior vena cava can prevent SFSS. The end-side anastomosis of left branch of portal vein to inferior vena cava for shunt is safe and feasible.