肝脏血管解剖与活体肝移植供者选择

目的 研究肝脏血管解剖对选择活体肝移植供者的影响.方法 总结分析312名健康成年人接受活体供肝移植供者评估的临床资料,其中男性278名,女性34名,年龄18～63岁,平均年龄29.3岁.所有受评估者均接受CT强化检查,并进行三维血管重建,观察肝脏血管走行,从而归纳出血管解剖对活体肝移植供者选择的影响.并观察其术后效果.结果 312名受评估者中,肝中动脉起源于肝左动脉的有218名(占69.9%).起源于肝右动脉的有89名(占28.5%),直接起源于肝总动脉的有5名(占1.6%).受评估者具有变异动脉的共有78名(占25%),其中具有副肝左动脉29名,具有副肝右动脉10名,具有替代肝左动脉29名,具有替代肝右动脉38人,其中多人同时具有两支变异动脉.门静脉的分型依据京都大学分型标准,门静脉I型有265名(占84.9%),Ⅱ型有25名(占8%),Ⅲ型有16名(占5.1%),Ⅳ型有6名(占2%),未发现门静脉V型者.Ⅳ段肝静脉汇入肝中静脉的有88名(占28.2%),汇入肝左静脉的为7名(占2.2%),汇入肝中静脉和肝左静脉的共有217名(占69.6%).共有221名受评估者具有右下静脉(占70.8%),其中89例具有两支及两支以上右下静脉.最终有194名受评估者作为肝移植供者接受了手术.结论 肝动脉具有较高的变异率;有Ⅰ～Ⅲ型门静脉者均可作为活体肝移植供者的选择条件;准确了解供肝血管解剖及正确的手术设计是保证活体肝移植供、受者手术成功的先决条件.

The relationship of liver blood vessel and donor of living donor liver transplantation

Objective To investigate the relationship of liver blood vessel and donor of living donor liver transplantation.Methods Clinical data of 312 health people under the donor estimate of the living donor liver transplantation were reviewed and analyzed retrospectively.There were 278 males and 34 females aged 18-63 years old (mean 29.3).All of them were checked by CT scan,the blood vessels were observed by three-dimensional reconstruction,and the relationship of liver blood vessels and choice of the donor of living donor liver transplantation was analyzed.Results Among 312 cases,middle arteria hepatica came from the left arteria hepatica in 218 cases (69.9%),from the right middle arteria hepatica in 89 cases (28.5%),and directly from the arteria hepatica communis in 5 cases(1.6%).There were 78 cases (25%) having the arteria hepatica variation.There were 29 cases having accessory left hepatic artery,10 cases having accessory right hepatic artery,29 cases having replaced left hepatic artery,38 cases having replaced fight hepatic artery,and some cases having two aneria hepatica variations.The type of portal vein was subtyped by Kyoto university type:type I,265 cases(84.9%);type Ⅱ,25 cases(8%);type Ⅲ,16 cases(5.1%),type Ⅳ,6 cases (2%).The ponal vein of type V was not found. There were 88 cases (28.2%) having Ⅳ section vein into the middle hepatic vein,only 7 eases (2.2%) into the left hepatic vein,and 217 cases (69.6%) into the middle hepatic vein and left hepatic vein.There were 221 cases (70.8%)having the lOW right hepatic vein,including 89 cases having two or more than two low right hepatic veins.At last 194 cases became the donor to receive the operation.Conclusion There is high variation rate of arteria hepatica. No matter the type of portal vein is type Ⅰ, type Ⅰ or type Ⅱ, they all can be the donor. We should try to keep the larger low right hepatic veins and anastomose them. The clear anastomosis of vessels and right design of the operation are the keys to achieve the success of the operation for the recipient and the donor.