流域学说指导下的小肝综合征处置

Management of small-for-size syndrome under guidance of liver dynamic watershed theory

小肝综合征(small-for-size syndrome,SFSS)常见于剩余肝体积不足以维持正常功能的术后患者中,是肝移植和扩大肝切除术后常见的临床综合征。近年来,多项研究发现SFSS的发生不仅取决于残余肝体积的大小,更与术后肝血供特别是门静脉的过度灌注相关。肝血流流域学说将肝内血液的分布类比为河流流域,相比于传统Couinaud分段,流域学说更关注活体肝血流的动态变化。本文从肝血流流域学说的角度为SFSS的病因及防治措施提出处置思路,为下一步研究提供前瞻方向。

Small-for-size syndrome is a common clinical syndrome after liver transplantation and hepatectomy,which is common in postoperative patients with insufficient residual liver volume to maintain normal function.In recent years,several studies have found that progression of small-for-size syndrome is not determined only by the“size”of the liver graft or remnant,but by the hemodynamic parameters of the postoperative hepatic circulation,especially portal vein flow.The liver dynamic watershed theory analogizes the hepatic blood flow to a river.Compared with the traditional Couinaud segmentation,the dynamic watershed theory pays more attention to the dynamic changes of hepatic blood flow.This paper provides a new perspective to understand the etiology and prevent small-for-size syndrome.