儿童活体左外叶肝移植肝中静脉汇入型S3肝静脉的重建策略及预后  

Reconstructing S3 hepatic vein with middle hepatic vein confluence in pediatric living donor liver transplantation using left lateral segment

作　　者：张威[1] 解恩博 孙超[1] 董冲[1] 王振[1] 徐敏 杨洋[1] 张国锋 郑卫萍[1] 高伟[1] Zhang Wei;Xie Enbo;Sun Chao;Dong Chong;Wang Zhen;Xu Min;Yang Yang;Zhang Guofeng;Zheng Weiping;Gao Wei(Department of Children's Organ Transplantation,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院儿童器官移植科,天津300192

出　　处：《中华器官移植杂志》2023年第3期160-166,共7页Chinese Journal of Organ Transplantation

摘　　要：目的探讨儿童活体左外叶肝移植肝中静脉汇入型S3肝静脉的重建策略及技术选择,以降低使用解剖变异的移植物引发的血管并发症风险。方法回顾性分析天津市第一中心医院2015年1月至2021年6月840例儿童活体左外叶肝移植供受者资料,其中肝中静脉汇入型S3肝静脉供肝的受者作为观察组(32例),余808例作为对照组,变异总体发生率为3.81%。观察组根据变异的具体情况及可获得的间置血管的不同分成两组,采取个体化的重建策略,观察组根据变异的具体情况及可获得的间置血管的不同采取单口重建或双口重建策略。观察组32例根据血管重建方式不同分为单口重建组(Ⅰ组,S3间置静脉后与S2静脉成形为单一开口再与受者吻合,21例)和双口重建组(Ⅱ组,将供肝S2静脉与受者肝左、肝中共干吻合,S3直接或间置血管后与受者肝右静脉残端吻合,11例)。比较两组受者的具体临床特征及预后,肝静脉流出道梗阻(hepatic venous outflow obstruction,HVOO)的发生率、治疗方法及预后;比较观察组与对照组HVOO的发生率。结果本研究观察组32例受者肝移植术后中位随访时间为23.8个月,HVOO发生率为15.6%;对照组808例儿童受者活体左外叶肝移植术后HVOO的发生率为4.5%,两组比较差异有统计学意义(P=0.014)。Ⅰ组、Ⅱ组间术后2周S3肝静脉超声血流速度差异有统计学意义[(39.15±16.37)cm/s比(20.05±8.52)cm/s,P=0.001],Ⅰ、Ⅱ组分别有7例和6例发生HVOO,差异无统计学意义(P=0.310)。观察组受者未出现无法解决的血管并发症,异体及自体间置血管搭桥远期通畅率满意,未出现由HVOO引发的移植物失功及儿童受者死亡。结论本中心关于肝中静脉汇入型S3肝静脉的重建策略及技术选择合理、安全、有效,总体治疗效果满意,多维重建方式的合理选择及各种技术的精准应用有利于改善儿童活体左外叶肝移植受者的预后。Objective To explore the reconstruction strategy and technical selection of S3 hepatic vein with middle hepatic vein confluence in pediatric liver transplantation(LT)using living donor left lateral segment to lower the risk of vascular complications caused by variant grafts.Methods From January 2015 to June 2021,retrospective analysis is performed for 840 consecutive cases of pediatric living donor LT using left lateral segment(LLS).There are 32 cases of S3 hepatic vein with middle hepatic vein confluence with an overall incidence of 3.81%.Individualized reconstruction strategies are implemented according to the specific conditions of variation and different interposition vessels available:group I unification venoplasty technique with interposition vein graft is employed for reconstructing HV from grafts,prolonged S3 is formed into a single opening with S2 and then anastomosed with recipient(21 cases);groupⅡdual HV reconstructions were performed(11 cases);venoplasty of recipients'LHV,MHV and inferior vena cava(IVC)is performed for creating a large orifice for anastomosis with S2 HV from graft and S3 is anastomosed with stump of recipient right HV directly or interposed blood vessels.Clinical features and prognosis of two groups,the incidence,treatment and prognosis of HVOO and the incidence of HVOO between variant and non-variant groups were compared.Results The median follow-up time of variant group(32 cases)is 23.8 month with an incidence of HVOO at 15.6%.During the same period,the non-variant group incidence of HVOO is 4.5%.There is inter-group statistical difference(P=0.014).The only statistical difference between groupsⅠandⅡis ultrasonic blood flow velocity of S3 HV at 14 POD[(39.15±16.37)vs(20.05±8.52)cm/s,P=0.001].HVOO occurred in 7 cases and 6 cases respectively in groupⅠand groupⅡ.There is no statistical difference(P=0.310).There are no intractable vascular complications.Long-term vascular patency of allogeneic and autologous interposition vein is satisfactory and there is no graft failure or

关 键 词：肝移植 儿童 肝静脉重建 

分 类 号：R726.5[医药卫生—儿科]