基于肝中静脉辖区体积优化活体右半肝移植供肝切取手术的规划  

Optimizing plan for right lobe living donor hepatectomy based on the territorial volume drained by the middle hepatic vein

作　　者：冷建军[1] 董家鸿[1] 段伟东[1] 王宏光[1] 叶晟[1] 史宪杰[1] 纪文斌[1] 陈永亮[1] 梁雨荣[1] 余强[1] 张煊[1] 赵莉[1] 

机构地区：[1]解放军总医院肝胆外科,北京100853

出　　处：《中华普通外科杂志》2012年第10期777-780,共4页Chinese Journal of General Surgery

基　　金：中国博士后科学基金特别资助项目（200902676）

摘　　要：目的通过供者术前影像资料，探讨基于肝中静脉辖区体积的优化活体右半肝移植供肝切取规划。方法采用磁共振动态增强扫描影像，按肝中静脉是否包含在右半供肝虚拟设计三种供肝切取的肝实质离断平面，分别计算右半供肝体积、供者剩余肝体积和剩余肝功能性体积，选择能同时满足移植肝受者体重比〉0．8％和供者剩余肝功能性体积〉35％供者标准肝体积的最佳肝实质离断分割平面。结果本组行活体肝移植71例，其中右半供肝移植（S5-8）65例，包含肝中静脉（in—MHV）43例（66．2％，43／65），含部分肝中静脉8例（12．3％，8／65），不含肝中静脉14例（21．5％，14／65）。供者术后无死亡者，术后并发症率为10．76％（7／65）。受者围手术期死亡率7．69％（5／65）；18例受体发生21例次并发症，并发症率为32．31％（21／65）。1年累积生存率为86％，2年累积生存率77％，3年为68％。结论利用供者术前影像基于肝中静脉辖区体积规划右半供肝切取平面可以获得安全可行的最佳供肝切取平面方案。Objective To optimize plan for right lobe living donor hepatectomy based on the territorial volume drained by the middle hepatic vein （MHV） as shown by preoperative MR image in donors. Methods Utilizing preoperative MR dynamic enhancement scanning image, virtually plot three types of hepatic parenchyma transsection plane based on the variation of including MHV for right lobe graft procurement. Results From June 2006 to May 2010, 65 adult-to-adult right lobe living donor liver transplantations was performed at General Hospital of Chinese PEA_, in which there were 43 grafts including MHV （66. 2%, 43/65 ）, eight grafts including partial MHV which was dissected before the V4b abouchement （12. 3%, 8/65） and 14 grafts not including MHV （21.5%, 14/65）. There was no postoperative death in donors and the postoperative complications developed in 10. 76% （7/65）. The recipients＇ perioperative mortality was 7.69% （5/65）. Ttwenty-one complications developed in 18 recipients, and the morbidity was 32. 31%. The cumulative survival rates were 86%, 77% and 68% respectively for 1, 2 and 3 years. Conclusions The optimizing liver resection plane could be practically designed preoperatively for fight lobe graft procurement based on the territorial volume drained by MHV.

关 键 词：肝移植 活体供者 肝中静脉 肝体积 

分 类 号：R657.3[医药卫生—外科学]