【摘要】 目的研究移植血管在成人间活体右半肝移植(LDLT)中的应用。方法对26例成人间LDLT患者,用大隐静脉重建肝Ⅴ、Ⅷ段肝中静脉粗大属支,及右肝下静脉,用大隐静脉补片修补供体门静脉损伤、狭窄以及肝动脉搭桥。结果利用大隐静脉重建Ⅴ、Ⅷ段肝中静脉粗大属支和右肝下静脉流出道20例,其总的重建率76．9%(20/26),其中重建一支静脉15例,重建两支静脉5例。重建引流的模式和病例数如下：Ⅴ53例,Ⅴ82例,Ⅴ5和Ⅴ83例,Ⅴ5和右肝下静脉1例,Ⅴ8和右肝下静脉1例,右肝下静脉10例。肝动脉搭桥率11．5%(3/26),肝动脉和腹主动脉间大隐静脉搭桥2例,肝动脉与肝动脉间大隐静脉搭桥1例。供体门静脉补片1例。所有病例术中和术后随访2～48月,超声检查均未发现血栓,血流通畅。结论自体大隐静脉在LDLT术中重建Ⅴ5、Ⅴ8及右肝下静脉流出道和肝动脉搭桥,能有效预防小肝综合征和动脉并发症。更多还原

【Abstract】 Objective To study the use of vein grafts in adult-to-adult(AA)living donor liver transplantation(LDLT), we transplanted recipient vena saphena magna grafts for drainage of the paramedian portion of the right lobe liver grafts without a middle hepatic vein in LDLT.Methods From January 2002 to March 2006,26 patients underwent A-A LDLT,and recipient saphenous vein grafts were used for revascularization of veins and arteries such as:tributaries of the middle hepatic vein from V5,V8;right inferior hepatic vein;injured portal vein;and hepatic artery.Results Total outflow reconstruction ratio of V5, V8 and right inferior hepatic vein was 76.9%(20/26),the ratio of one-vein reconstruction was 57.7%,and the ratio of two- vein reconstruction was 19.2%.Reconstruction patterns and cases were demonstrated as follows:V5(n=3),V8(n=2),V5 and V8(n=3),V5 and right inferior hepatic vein(n=1),V8 and right inferior hepatic vein(n=1),right inferior hepatic vein (n=10),injured portal vein of the donor(n=1).Total ratio of hepatic artery bypass grafting was 11.5%(3/26),anastomosis between hepatic artery and abdominal aorta(n=2),and anastomosis between hepatic artery and hepatic artery(n=1). Doppler ultrasound showed no thrombosis and the blood flowed smoothly and without venous outflow obstruction during the 2 to 48 months follow-up period.Conclusion Reconstruction of V5 or V8 outflow and hepatic artery bypass grafting using vena saphena magna of the recipients can provide sufficient venous outflow and prevent the small-for-size syndrome and solve hepatic artery complications.This approach can be recommended.更多还原