成人间右半肝活体肝移植肝中静脉的处理

目的 总结成人间右半肝活体肝移植肝中静脉的处理经验。方法 回顾性分析两例成人间右半肝活体肝移植肝中静脉的处理方法，1例采取含肝中静脉的右半肝活体肝移植，肝中静脉移植供肝和剩余肝脏各保留一半，既有利于保证供体左肝内叶静脉回流，同时供肝右前叶静脉回流也不受到影响；另1例则采取不含肝中静脉的右半肝活体肝移植，术中重建供肝右前叶肝静脉回流通道，使供肝前叶淤血明显改善。结果 两例供体均存活，术后顺利出院，无并发症；受体1例存活，1例术后20d死于急性重度排斥反应。结论 成人间右半肝活体肝移植肝中静脉的处理十分关键，要注意保持供受体肝流出道的通畅，既要保证供体的绝对安全，又要尽量为受体提供足够的肝容量。

Management of middle hepatic vein in adult-to-adult living right hemihepatic transplantation

Objective To summarize the experience in management of the middle hepatic vein in adult-to-adult living right hemihepatic transplantation. Methods The management of the middle hepatic vain in 2 cases of adult-to-adult living right hemihepatic transplantation was reviewed. In 1 case, half of the middle hepatic vein was transplanted along with the right hemihepatic graft. It ensured the venous drainage of the left medial lobe of liver. Meanwhile, the venous drainage of the right anterior lobe of the graft would not be impaired. In the other case, the right hemihepatic graft was transplanted without the middle hepatic vein and reconstruction was performed for venous drainage of the right anterior lobe. Results Two donors survived from the operation and no complication occurred. One recipient survived from the operation but the other died from acute rejection on the postoperative 20th d. Conclusions Management of the middle hepatic vein is one of the key points in adult-to-adult living right hemihepatic transplantation. The venous outflow of both recipient and donor livers should be kept patent. The safety of the donor should be absolutely assured. Meanwhile, the volume of liver graft for recipients should be adequate.