肝左静脉分型对患儿活体左外叶肝移植肝静脉重建方式及预后的影响  

Impact of left hepatic vein classification on hepatic vein reconstruction and prognosis after pediatric living-donor liver transplantation using left lateral liver segments

作　　者：王若凡 董冲[2] 孙超[2] 王凯[2] 张威[2] 郑卫萍[2] 覃虹[2] 韩潮[2] 杨洋[2] 张复波[2] 魏新哲 高伟[2] Wang Ruofan;Dong Chong;Sun Chao;Wang Kai;Zhang Wei;Zheng Weiping;Qin Hong;Han Chao;Yang Yang;Zhang Fubo;Wei Xinzhe;Gao Wei(The First Central Clinical School,Tianjin Medical University,Tianjin 300192,China;Department of Pediatric Liver Transplantation,Organ Transplantation Center,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津医科大学一中心临床学院,天津300192 [2]天津市第一中心医院器官移植中心儿童器官移植科,天津300192

出　　处：《中华肝胆外科杂志》2022年第6期419-424,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：中国器官移植发展基金会"菁英计划"(2019JYJH03)

摘　　要：目的探讨供肝左静脉分型及其相应的重建方式对患儿活体左外叶肝移植术后肝静脉流出道梗阻(HVOO)的影响。方法回顾性分析2014年1月至2020年12月在天津市第一中心医院行肝移植术的653例受者的临床资料,其中男性309例,女性344例,年龄7.0(6.0,10.0)个月,年龄范围3~121个月。根据术前供者腹部4期增强CT的评估结果及术中流出道重建方式,将患儿分为3组:Ⅰ型组(n=514),单只开口,供受体直接吻合;Ⅱ型组(n=118),两个相邻的开口,术中先行血管成型再吻合;Ⅲ型组(n=21),两个距离较远的开口,术中行间置血管延长后成型吻合或两支静脉分别吻合。比较3组受者的临床资料、术后HVOO发生率、移植物及受者术后生存情况。采用电话随访或门诊复查随访。结果Ⅲ型组患儿的供肝重量与受者体重比均小于Ⅰ型组和Ⅱ型组,差异均具有统计学意义(P<0.05)。653例受者术后HVOO发生率为4.59%(30/653),Ⅰ、Ⅱ、Ⅲ型组HVOO发生率分别为4.1%(21/514)、5.1%(6/118)和14.3%(3/21),组间比较差异均无统计学意义(P>0.05)。Ⅰ型组移植后患儿1和3年累积生存率分别为97.8%和97.0%,Ⅱ型组1和3年的累积生存率分别为96.5%和94.2%,Ⅲ型组1和3年累积生存率分别为94.1%和86.9%,Ⅰ型组与Ⅲ型组受者术后累积生存率差异具有统计学意义(P=0.048)。Ⅰ型组术后移植物1和3年的累积生存率分别为97.4%和96.9%,Ⅱ型组术后移植物1和3年累积生存率分别为94.9%和92.5%,Ⅲ型组术后移植物1和3年累积生存率分别为94.1%和86.9%,Ⅰ型组与Ⅱ型组术后移植物累积生存率差异具有统计学意义(P=0.044)。结论肝左静脉解剖分型差异性大,绝大多数变异可通过将两分支血管成型为共同开口后再吻合这一方式重建流出道。针对左外叶移植物肝静脉罕见变异分型,选取合理的血管重建术式,可降低术后HVOO发生率,改善移植物预后。Objective To study the impact of donor left hepatic vein classification and the reconstruction methods on hepatic venous outflow obstruction(HVOO)after pediatric living-donor liver transplantation using left lateral liver segments.Methods A retrospective study was performed on the clinical data of 653 children recipients who underwent living-donor liver transplantation with left lateral liver segments from January 2014 to December 2020 at Tianjin First Central Hospital.There were 309 males and 344 females,aged 7.0(6.0,10.0)months,with an age range of 3-121 months.Based on the left hepatic vein on preoperative donor enhancement CT as well as the intraoperative reconstruction methods,the recipients were divided into 3 groups:typeⅠgroup(n=514),anastomosis using a single opening was performed directly between the donor and the recipient;typeⅡgroup(n=118),angioplasty was performed on two adjacent recipient venous orifices before anastomosis,and typeⅢgroup(n=21),an interposition vessel was anastomosed to two widely spaced openings or the two veins were anastomosed separately.The preoperative general status of the patient,postoperative HVOO incidences,and graft and recipient survival rates were compared among the three groups.The patients were followed up by outpatient reexamination or telephone.Results Graft to recipient weight ratio in the typeⅢgroup was smaller than that in the typeⅠgroup and the typeⅡgroup(P<0.05).For all the 653 patients,the incidence of postoperative HVOO was 4.59%(30/653),with the incidences of HVOO in the 3 groups of patients were 4.1%for the typeⅠgroup(21/514),5.1%for the typeⅡgroup(6/118),and 14.3%for the typeⅢgroup(3/21),respectively.There was no significant difference among the groups(P>0.05).The recipient cumulative survival rates at 1 and 3 years after surgery in the type I group were 97.8%and 97.0%,and the corresponding rates in the typeⅡgroup were 96.5%and 94.2%,and in the typeⅢgroup were 94.1%and 86.9%,respectively.There was a significant difference between the typ

关 键 词：肝移植 BUDD-CHIARI综合征 肝静脉 流出道重建 

分 类 号：R726.5[医药卫生—儿科]