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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

易述红, 杨卿, 傅斌生, 等. 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[J]. 器官移植, 2022, 13(6): 764-769. doi: 10.3969/j.issn.1674-7445.2022.06.011
引用本文: 易述红, 杨卿, 傅斌生, 等. 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[J]. 器官移植, 2022, 13(6): 764-769. doi: 10.3969/j.issn.1674-7445.2022.06.011
Yi Shuhong, Yang Qing, Fu Binsheng, et al. Design and clinical application of simplified 'All in one' hepatic vein reconstruction in right split liver transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(6): 764-769. doi: 10.3969/j.issn.1674-7445.2022.06.011
Citation: Yi Shuhong, Yang Qing, Fu Binsheng, et al. Design and clinical application of simplified "All in one" hepatic vein reconstruction in right split liver transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(6): 764-769. doi: 10.3969/j.issn.1674-7445.2022.06.011

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

doi: 10.3969/j.issn.1674-7445.2022.06.011
基金项目: 

国家重点研发计划项目 2017YFA0104304

国家自然科学基金 81972286

国家自然科学基金 81770648

广东省自然科学基金 2020A1515010574

详细信息
    作者简介:
    通讯作者:

    杨扬,博士,主任医师,研究方向为肝移植,Email:yysysu@163.com

  • 中图分类号: R617, R575

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

More Information
  • 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。

     

  • 图  1  2例受者的肝静脉重建方案

    注:A图为例1的肝静脉重建方案,S5、S8段肝静脉采用髂动脉搭桥直接吻合于下腔静脉缺口,重建了下腔静脉的完整性(原缺口过大予以部分缝闭);B图为例2的肝静脉重建方案,S5、S8段肝静脉采用髂动脉搭桥直接吻合于下腔静脉缺口,重建了下腔静脉的完整性;C图为重建后完整的肝后下腔静脉,可以采用经典或背驮式肝移植术式。

    Figure  1.  Hepatic venous remodeling regimen of 2 recipients

    图  2  2例受者的供肝回流情况

    注:A图为例1右半肝开放后,搭桥的髂动脉内血液充盈满意;B图为例2右半肝开放后,搭桥的髂动脉内血液充盈满意。

    Figure  2.  Condition of donor liver reflux of 2 recipients

    图  3  2例受者的供肝淤血肿胀情况

    注:A图为例1右半肝,开放后肝脏无淤血肿胀,仅在S5段边缘有部分淤血改变;B图为例2右半肝,开放后肝脏无淤血肿胀。

    Figure  3.  Blood swelling of donor livers of 2 recipients

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出版历程
  • 收稿日期:  2022-09-01
  • 网络出版日期:  2022-11-14
  • 刊出日期:  2022-11-15

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