带肝中静脉的活体右半肝移植供者Ⅳ段肝静脉分型对术后残肝淤血和再生的影响  

The effect of segment Ⅳ hepatic vein＇s anatomy on remnant liver congestion and regeneration in right lobe liver graft donors with inclusion of the MHV

作　　者：蒋文涛[1] 马楠[1] 王洪海[1] 张骊[1] 郭庆军[1] 潘澄[1] 邓永林[1] 郑虹[1] 朱志军[1] 沈中阳[1] 

机构地区：[1]天津医科大学一中心临床学院天津市第一中心医院器官移植中心,300192

出　　处：《中华普通外科杂志》2013年第3期173-177,共5页Chinese Journal of General Surgery

基　　金：天津市科委重点基金资助项目（10ZCGYSF00500）,天津市卫生局面上基金资助项目（09KY09）

摘　　要：目的了解带肝中静脉活体右半肝移植供者Ⅳ段肝静脉分型对术后残肝淤血和肝脏再生的影响。方法回顾性分析44例带肝中静脉活体右半肝供者临床资料。依据Nakamura分型于术前应用IQQA—MSCT对Ⅳ段静脉分型，术中验证分型。术后2周行CT检查判断Ⅳ段淤血情况，应用IQQA—MSCT测量残肝体积。结果IQQA—MSCT可对Ⅳ段肝静脉进行三维重建并分型，其分型结果得到术中证实。Ⅰ、Ⅱ和Ⅲ型Ⅳ段严重淤血的发生率分别为3．8％，40．0％和37．5％，三型比较差异有统计学意义（χ2=9．004，P=0．007）。术后两周左外叶体积Ⅰ型（599±78）ml显著小于Ⅱ型（698±40）ml（F=7．977，P=0．01）和Ⅲ型（675±67）ml（F=7．977，P=0．032）；而左内叶体积Ⅰ型（357±69）ml显著大于Ⅱ型（262±39）ml（F=6．541，P=0．005）和Ⅲ型（273±33）ml（F=6．541，P=0．014）。Ⅰ型Ⅳ段再生比例显著大于Ⅱ型（F=4．14，P=0．027）和Ⅲ型（F=4．14，P=0．04）；与之相反Ⅰ～Ⅲ段的再生比例则是Ⅰ型显著小于Ⅱ型（F=5．577，P=0．005）和Ⅲ型（F=5．577，P=0．047）；而3组残肝的再生比例差异无统计学意义（F=1．831，P=0．173）。残肝体积与术前全肝体积的比值比较差异无统计学意义（F=2．37，P=0．561）。结论IQQA—MSCT是良好的活体肝移植供体评估方法。Ⅳ段肝静脉解剖分型与带肝中静脉活体右半肝移植残肝淤血相关，Ⅰ型淤血程度最轻。残肝淤血对所累及肝段再生有不利影响，但不影响残肝总体再生。Objective To investigate the effect of segment Ⅳ hepatic vein＇s type on the early remnant liver congestion and regeneration in right lobe living-related liver graft donors （LDLT） with the inclusion of middle hepatic vein （MHV）. Methods Between October 2008 and April 2010,44 LDLT with MHV were performed. According to the type of Nakamura, we classified the segment Ⅳ hepatic vein by means of IQQA-MSCT and verified in operartion. We measured the volume of remnant liver by means of IQQA-MSCT and judged the congestion of segmentⅣ through postoperative CT scan. Results IQQA- MSCT was an effective method to construct and sort segment Ⅳ hepatic vein, which was verified by operartion. The ratio of serious segment Ⅳ congestion was 3.8% in type Ⅰ , 40. 0% in type Ⅱ , 37.5% in type Ⅲ, and the difference was significant（χ2 =9. 004,P =0. 007）. Two weeks post operation, the volume of segments Ⅰ - Ⅲ in type Ⅰ was smaller than in type Ⅱ （ F = 7. 977, P = 0. 01 ） and type Ⅲ（ F = 7. 977, P = 0. 032）, the volume of segment IV in type I was bigger than in type Ⅱ （F = 6. 541 ,P = 0. 005） and type Ⅲ （F = 6. 541,P = 0. 014） conversely. The regeneration rate of segment Ⅳ in type Ⅰ was bigger than in type Ⅱ （F = 4. 14,P = 0. 027） and typeⅢ（ F = 4. 14, P = 0. 04）, on the contrary, the regeneration rate of segments Ⅰ - Ⅲ in type Ⅰ was smaller than in in type Ⅱ （ F = 5. 577, P = 0. 005 ） and type Ⅲ （ F = 5. 577 ,P =0. 047）. But the regeneration rate of remnant liver was not different between the three groups（ F = 1. 831, P=0. 173 ）. Conclusions IQQA-MSCT was an effective method to evaluate the donor in LDLT. The type of segment Ⅳ hepatic vein affected the remnant liver＇s congestion and regeneration. The segment Ⅳ hepatic vein＇s anatomy was significantly related with the postoperative congestion and regeneration of the remnant liver, which was compensated by the regeneration of segments Ⅰ - Ⅲ.

关 键 词：肝移植 活体供者 肝再生 淤血 

分 类 号：R657.3[医药卫生—外科学]