带肝中静脉的活体右半肝移植供者Ⅳ段肝静脉分型对术后残肝淤血和再生的影响

蒋文涛.带肝中静脉的活体右半肝移植供者Ⅳ段肝静脉分型对术后残肝淤血和再生的影响[J].中华普通外科杂志.2013.28（3）：173-177

肝移植;活体供者;肝再生;淤血

蒋文涛，马楠，王洪海，张骊，郭庆军，潘澄，邓永林，郑虹，朱志军，沈中阳

300192天津医科大学一中心临床学院 天津市第一中心医院器官移植中心

2013

173-177

知网

目的了解带肝中静脉活体右半肝移植供者Ⅳ段肝静脉分型对术后残肝淤血和肝脏再生的影响。 方法 回顾性分析佴 例带肝中静脉活体右半肝供者临床资料。依据 Nakamura分 型于术前应用IQQA-MSCT对Ⅳ段静脉分型,术中验证分型E术后2周行CT检查判断Ⅳ段淤血情况,应用IQQ肛MSCT测 量残肝体积。 结果 IQQA-MSCT可对Ⅳ段肝静脉进行三维重建并分型,其分型结果得到术中证实。I、Ⅱ和Ⅲ型Ⅳ段严重淤血的发生率分别为38%,40%和37.5%,三型比较差异 有 统 计学意 义(X2=9.004,P=0.007)。 术后两周左外叶 体积I型 (599± 78)ml显著小于Ⅱ 型(698± 40)ml(F=7.9刀 ,P=0..01)和 Ⅲ型(675±67)lml(F=7.977,P=0.032);而左内叶体积 I型(357±69)ml显著大于 Ⅱ型(262±39)ml(F=6.541,P=0.005)和 Ⅲ型(273± 33)ml(F=6.541,P=0.014)。 I型 Ⅳ段再生比例显著大于 Ⅱ型(F=414,P=0.027)和 Ⅲ型(F=4.14,P=0.04);与之相反 I~Ⅲ段的再牛比例则是 I型显著小于Ⅱ型(F=5.577,P=0.005)和 Ⅲ型(F=5.577,P=0.047);而 3组残肝的再生比例差异无统计学意义(F=1831,P=0173)。残 肝体积与术前伞肝体积的比值比较差异无统计学意义(F=2.27,P=0.561)。 结论IQQ-MSCT是良好的活体肝移植供体评估方法。Ⅳ段肝静脉解剖分型与带肝中静脉活体右半肝移植残肝淤血相关,I型淤血程度最轻。残肝淤血对所累及肝段冉生有不利影响,但不影响残肝总体再生。 objective to investigate the effect of segment IV hepatic vein’s type on the early remnant liver congestion and regeneration in right lobe living-related liver graft donors (LDLT) with the inclusion middle hepatic vein (MHV).Methods Between October 2008and April 2010,44LDLT with MHV were performed. According to the type of Nakamura, we classified the segment IV hepatin vein by lQQA-MSCT and judged the congebtion of segment IV through postoperathc CT scan ResuIts IQQA-MSCT was an effectivc method to cons1ruct and sortsegment IV. Hepatic vein, which was verifled by operarton The ratio serious segment IⅤ congestion was3.8% in type I,40% in type Ⅱ, 37.5%in type Ⅲ,and thc difference was significant(x2=9 .004,P=0.007). Two weeks post operatlon, the Volume of segments I-Ⅲ in type I was smaller than in type Ⅱ(F=7.977,P=0.01)and type Ⅲ(F=7.977,P=0.032),the volume of segment IV in type I was bigger than in type Ⅱ(F=6.541,P=0.005) and type Ⅲ (F=6.541,P=0.014)conversely .The regeneration rate of segment Ⅳ in type I was bigger than in type Ⅱ(F=4 .14,P=0.027) and type Ⅲ (F=4 .14,P=0.04),on the contrary,,the regeneration rate of segments I -Ⅲ in type I was smdler than in in type Ⅱ(F=5.577,P=0.005)and type Ⅲ (F=5 .577,P=0.047) .But the regenration rate of remnant liver was not different between the three groups (F=1.83I,P=0.173), Conclusions IQQA-MSCT was an effective method to evalution the donor in LDLT .The type of segment IV hepatic vein affectcd the remnant liver′ s congestion and regeneration. The segment Ⅳ hepatic vein′ s anatomy was significantly relaled wilh the postoperative congestion and regeneration of the lemnant liver,which was compensated by the regeneratlon of segmentes I -Ⅲ.