右半肝活体移植术中MHV与RHV间侧支静脉开通现象的观察  

Observation of the ppening in hepatic venous collaterals between MHV and RHV in LDLT patients with right liver graft

作　　者：朱晓丹[1] 沈中阳[1] 陈新国[1] 臧运金[1] 任秀昀[1] 范宁[1] 

机构地区：[1]武警总医院器官移植研究所,北京100039

出　　处：《中国现代普通外科进展》2015年第2期113-117,126,共6页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:观察右半肝活体移植术中MHV与RHV间侧支静脉开放的情况及其对移植肝功能恢复的影响。方法:回顾性分析武警总医院2007年3月20日—2013年3月19日进行的右半肝活体移植手术98例。其中MHV阻断组的右半肝移植受者41例(包括未进行MHV重建的33例及进行了MHV重建但术后12h内重建血管无血流的8例),MHV开放组的右半肝移植受者57例(包括切取带MHV的29例及进行MHV重建、持续通畅的28例)。收集两组受者术前、术后第1天、术后第3天及术后第7天的ALT、AST、TBIL结果,收集两组受者术后2周内彩超检查所见。结果:两组供体的参数比较差异无统计学意义(P>0.05)。全部病例均顺利康复出院。MHV阻断组在术后第1周内Ⅷ段肝静脉与RHV间侧支静脉开通率为90.2%(37/41),Ⅴ段肝静脉与RHV间侧支静脉开通率为70.7%(29/41)。MHV阻断组的ALT、AST、TBIL水平较MHV开放组略高,但差异无统计学意义(P>0.05)。受者平均住院时间MHV阻断组较MHV开放组略长,两组差异无统计学意义(P>0.05)。彩超及DSA下均能发现侧支静脉开通的直接及间接证据。结论:在活体肝移植手术中,阻断MHV后大多数病例的MHV与RHV间侧支静脉可以出现开通的现象,阻断这一过程对移植肝功能的恢复无明显影响。Objective： To describe the postoperative detection of hepatic venous collaterals in right liver graft between MHV and RHV in LDLT, and evaluate the influence on the recovery of the planted liver function. Methods： Authors had retrospected 98 LDLT patients with right liver graft of General Hospital of Chinese Arm ed Police Force from March 20 th 2007 to March 19 th 2013. Patients were devided into two groups. There were 41 patients in MHV blocking-up group including 33 patients with non-reconstruction of MHV and 8 patients who were detected blocking of the reconstructed venous of MHV within 12 hrs after operation. And 57 patients in MHV opening-up group including 29 patients with MHV in graft and 28 patients whose reconstructed venous of MHV were consistently opened. The results of ALT, AST and TBIL of all patients were collected on four time points as preoperation, 1st day, 3rd day, and 7th day after operation. C ollected results including the detection of blood signal in blocked-up MHV with colored ultrasonic doppler machine every day in 2w ks after operation. D ata were analysed with softw are SPSS 11.5. Results： All operations were perform ed successfully and all cases were recovered com pletely. The opening rate of the collateral vein between segment Ⅷ vein and RHV was 90.2%（37/41）,and segment Ⅴ was 70.7%（29/41）in MHV blocking-up group within 1st week after operation. The indicators of the planted liver function in MHV blocking-up group were higher than those in MHV opening-up group in ALT, AST and TBIL.P value was above 0.05 in each compare data. There were no differences were found in the data of donors between two groups. The hospitalstays was no difference also in two groups. Direct and indirect evidences of the opening in collateral vein between MHV and RHV were found through D SA and colored ultrasonic doppler exam ine. Conclusion： The opening of collateral vein between MHV and RHV may be found in mang cases with blocked-up MHV right liver graft. There was no significant influence on

关 键 词：肝移植 活体 右半肝 肝中静脉 肝右静脉 侧支静脉 

分 类 号：R617[医药卫生—外科学]