右半肝劈离式肝移植的简化“All in one”肝静脉重建方式的设计和临床应用  

Design and clinical application of simplified“All in one”hepatic vein reconstruction in right split liver transplantation

作　　者：易述红[1] 杨卿[1] 傅斌生[1] 张彤[1] 姚嘉[1] 曾凯宁[1] 冯啸[1] 陈规划[1] 杨扬[1] Yi Shuhong;Yang Qing;Fu Binsheng;Zhang Tong;Yao Jia;Zeng Kaining;Feng Xiao;Chen Guihua;Yang Yang(Department of Liver Transplantation,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院肝移植中心,广州510630

出　　处：《器官移植》2022年第6期764-769,共6页Organ Transplantation

基　　金：国家重点研发计划项目(2017YFA0104304);国家自然科学基金(81972286、81770648);广东省自然科学基金(2020A1515010574);广州市临床高新技术(2023~2025)建设项目。

摘　　要：目的介绍右半肝劈离式肝移植时采用的简化“All in one”的肝静脉重建手术方式,探讨该术式的临床适应证、操作方式和预后。方法回顾性分析2例完全右半肝劈离式肝移植的病例资料,就右半肝肝静脉采用简化“All in one”重建方式进行总结分析。2例右半肝均为在体劈离,例1采用劈离肝实质至第一、二肝门,离断右肝管后整体灌注获取,台下分割肝脏血管的方法。例2采用在体劈离时先行获取左半肝,右半肝行在体灌注后获取。2例供肝劈离时均将肝中静脉主干保留于左半肝,右半肝的S5、S8段肝静脉采用同一供者髂动脉重建,并直接吻合于下腔静脉上原肝左和肝中静脉离断后的缺口,重建了肝后下腔静脉的完整性。结果采用简化“All in one”右半肝肝静脉重建方式,2例肝移植无肝期分别为41、36 min。肝脏开放后供肝回流良好,搭桥的髂动脉血管充盈满意,无肝脏淤血肿胀等表现,术后肝功能恢复顺利。分别随访1年11个月和10个月,无肝静脉和下腔静脉等流出道相关并发症发生。结论完全右半肝劈离式肝移植时,采用“All in one”的肝静脉重建方式可以简化移植肝脏流出道重建步骤、缩短无肝期时间,减少术后肝静脉并发症的发生。Objective To introduce the simplified“All in one”hepatic vein reconstruction in right split liver transplantation,and to investigate the clinical indications,surgical procedures and clinical prognosis of this technique.Methods Clinical data of 2 recipients undergoing right split liver transplantation were retrospectively analyzed,and the simplified“All in one”hepatic vein reconstruction of right liver lobe was summarized and analyzed.In 2 cases,the right liver lobe was split in vivo.In case 1,the liver parenchyma was split until the first and second porta hepatis,and then the liver was obtained by whole-liver perfusion after cutting off the right hepatic duct,and the hepatic blood vessels were isolated ex vivo.In case 2,the left liver lobe was obtained during splitting in vivo and the right liver lobe was obtained after perfusion in vivo.During donor liver splitting in two cases,the common trunk of the middle hepatic vein was maintained in the left liver lobe,the S5 and S8 hepatic veins of the right liver lobe were reconstructed by the same donor iliac artery,and directly anastomosed with the gap between the left and middle hepatic veins of the inferior vena cava,thus reconstructing the integrity of the posterior inferior vena cava.Results The simplified“All in one”right hepatic vein reconstruction was adopted.The anhepatic phase of two recipients undergoing liver transplantation was 41 and 36 min.After the liver was incised open,the blood flow of the donor liver was normal,the iliac artery bypass was fully filled,liver congestion or swelling was not observed,and liver function was properly recovered after surgery.Two recipients were subject to postoperative follow-up for 23 and 10 months,respectively,No complications related to hepatic venous outflow tracts were noted,such as hepatic vein and inferior vena cava.Conclusions“All in one”hepatic vein reconstruction may simplify the procedures of hepatic venous outflow tract reconstruction,shorten the anhepatic phase and reduce the incidence of postop

关 键 词：劈离式肝移植 右半肝 肝静脉重建 供肝修整 肝静脉回流 在体劈离 离体劈离 无肝期 

分 类 号：R617[医药卫生—外科学] R575[医药卫生—临床医学]