腹腔镜肝左外叶供肝获取术中供肝血管影像学解剖特征及其临床意义  

Imaging anatomical features of donor liver blood vessels in laparoscopic left lateral donor liver acquisition and clinical significance

作　　者：陆录[1] 朱文伟[1] 沈丛欢[1] 陶一峰[1] 王正昕[1] 钦伦秀[1] 陈进宏[1] Lu Lu;Zhu Wenwei;Shen Conghuan;Tao Yifeng;Wang Zhengxin;Qin Lunxiu;Chen Jinhong(Department of General Surgery,Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院普通外科,上海200040

出　　处：《中华消化外科杂志》2020年第2期185-190,共6页Chinese Journal of Digestive Surgery

基　　金：国家科技重大专项(2017ZX10203207)。

摘　　要：目的探讨腹腔镜肝左外叶供肝获取术中供肝血管的影像学解剖特征及临床意义。方法采用回顾性描述性研究方法。收集2016年10月至2018年12月复旦大学附属华山医院收治的39例活体肝移植供者的临床资料;男10例,女29例;年龄为(31±7)岁。同时收集39例活体肝移植受者的临床资料;男26例,女13例;年龄为8个月(4~68个月)。供者术前常规行腹部增强X线计算机体层摄影术检查、三维血管重建判断供肝血管解剖情况。供者均施行腹腔镜肝左外叶供肝获取术。观察指标:(1)术前影像学检查三维血管重建情况。(2)手术情况。(3)随访情况。采用门诊方式对受者进行随访,了解受者肝移植后并发症情况。随访时间截至2019年10月。正态分布的计量资料以±s表示,组间比较采用t检验。偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示。结果(1)术前影像学检查三维血管重建情况。39例供者术前影像学检查三维血管重建显示肝动脉和肝静脉解剖学特征包括:①肝动脉情况为11例供者存在肝中动脉,其中5例起始于肝右动脉,3例起始于肝右动脉和肝左动脉汇合处,3例起始于肝左动脉。2例供者肝左动脉解剖变异,均存在副肝左动脉,起始于胃左动脉。26例供者无肝中动脉,肝左动脉无解剖变异。②肝静脉情况:9例供者肝左静脉和肝中静脉分别汇入下腔静脉。7例供者存在肝左静脉左上缘支。23例供者肝左静脉与肝中静脉共干汇入下腔静脉。(2)手术情况。①39例供者均成功施行腹腔镜肝左外叶供肝获取术,手术时间为(160±32)min,术中出血量为(142±74)mL。②11例有肝中动脉供者中,8例为肝左动脉优势型,留取肝左动脉用于肝移植术中肝动脉吻合重建,3例肝中动脉起始于肝左动脉,留取肝左动脉和肝中动脉共干用于肝移植术中肝动脉吻合重建。2例肝左动脉解剖变异供者中,1例为副肝�Objective To investigate the imaging anatomical features of donor liver blood vessels in laparoscopic left lateral donor liver acquisition and their clinical significance.Methods The retrospective and descriptive study was conducted.The clinical data of 39 living donor liver transplantation(LDLT)donors who were admitted to Huashan Hospital Affiliated to Fudan University between October 2016 and December 2018 were collected.There were 10 males and 29 females,aged(31±7)years.The clinical data of 39 LDLT recipients were collected.There were 26 males and 13 females,aged 8 months(range,4-68 months).Abdominal enhanced computed tomography and three-dimensional vascular reconstruction were performed on donors to evaluate the anatomical characteristics of hepatic vessels.All the donors underwent laparoscopic left lateral donor liver acquisition.Observation indicators:(1)three-dimensional vascular reconstruction of preoperative imaging;(2)surgical conditions;(3)follow-up.Follow-up was performed using outpatient examination to detect complications of recipients after LDLT up to October 2019.Measurement data with normal distribution were expressed as Mean±SD,and comparison between groups was analyzed by the t test.Measurement data with skewed distribution were represented as M(range).Count data were expressed as absolute numbers or percentages.Results(1)Three-dimensional vascular reconstruction of preoperative imaging:the anatomical characteristics of hepatic artery and hepatic vein revealed by three-dimensional vascular reconstruction of preoperative imaging of 39 donors included①middle hepatic artery was present in 11 donors,among which 5 started from the right hepatic artery,3 from the confluence of the right and left hepatic artery,and 3 from the left hepatic artery.Two donors had anatomical variation in the left hepatic artery which was presentation of left accessory hepatic artery originated from the left gastric artery.The other 26 donors had no middle hepatic artery or anatomical variation in the left hepatic art

关 键 词：胆道疾病 肝脏疾病 供肝获取 活体肝移植 腹腔镜检查 

分 类 号：R657[医药卫生—外科学]