術中監測及調整門靜脈血流預防活體肝移植術后小肝綜合征_《中國普外基礎與臨床雜志》

作者：

孫超 , 朱志軍 , 蔣文濤 , 魏林 , 楊濤 , 張瑋曄 , 高彬

天津市第一中心醫院移植外科(天津 300192);

關鍵詞：

活體肝移植小肝綜合征血流動力學脾切除脾動脈結扎

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的探討活體肝移植術中門靜脈血流量及門靜脈壓力的監測及調整對小肝綜合征的預防作用。
方法回顧性分析我院移植一科2007年10月至2008年10月期間行活體肝移植并進行術中門靜脈血流監測的44例患者的臨床資料，包括實測供肝重量占受者體重比（GRWR）、門靜脈血流量及壓力、術后是否出現小肝綜合征表現等。對于實測GRWR偏小（GRWR lt;1%）的病例，如果術中門靜脈壓力＞12 mm Hg (1 mm Hg=0.133 kPa)或者門靜脈血流量＞250 ml/（min·100 g），在術中加行脾切除或脾動脈結扎，分析監測和調整門靜脈血流（脾切除和脾動脈結扎）是否可以預防小肝綜合征的發生。
結果行脾切除6例，切脾后門靜脈血流量及壓力均較切除前明顯降低（P lt;0.05）；脾動脈結扎7例，結扎后門靜脈壓力較結扎前明顯降低（P lt;0.05），而門靜脈血流量無明顯變化（P＞0.05）。術后44例患者均未出現小肝綜合征表現。
結論活體肝移植術中通過切脾或行脾動脈結扎降低移植肝門靜脈血流量及壓力對術后小肝綜合征有預防作用

引用本文： 孫超,朱志軍,蔣文濤,魏林,楊濤,張瑋曄,高彬. 術中監測及調整門靜脈血流預防活體肝移植術后小肝綜合征. 中國普外基礎與臨床雜志, 2010, 17(5): 415-419. doi: 復制

1.	Tanaka K, Ogura Y. “Small-for-size graft” and “small-for-size syndrome” in living donor liver transplantation [J]. Yonsei Med J, 2004; 45(6): 1089-1094.
2.	Heaton N. Small-for-size liver syndrome after auxiliary and split liver transplantation: donor selection [J]. Liver Transpl, 2003; 9(9): S26-S28.
3.	Troisi R, Ricciardi S, Smeets P， et al. Effects of hemi-portocaval shunts for inflow modulation on the outcome of small-for-size grafts in living donor liver transplantation [J]. Am J Transplant, 2005; 5(6): 1397-1404.
4.	Boillot O, Delafosse B, Méchet I, et al. Small-for-size partial liver graft in an adult recipient; a new transplant technique [J]. Lancet, 2002; 359(9304): 406-407.
5.	Man K, Fan ST, Lo CM, et al. Graft injury in relation to graft size in right lobe live donor liver transplantation: a study of hepatic sinusoidal injury in correlation with portal hemodynamics and intragraft gene expression [J]. Ann Surg, 2003; 237(2): 256-264.
6.	Ikegami T, Shimada M, Imura S, et al. Current concept of small-for-size grafts in living donor liver transplantation [J]. Surg Today, 2008; 38(11): 971-982.
7.	Sanefuji K, Iguchi T, Ueda S, et al. New prediction factors of small-for-size syndrome in living donor adult liver transplantation for chronic liver disease [DB/OL]. Transpl Int. [Epub ahead of print]. http://www.ncbi.nlm.nih.gov/pubmed/ 19843295. Oct 19, 2009.
8.	Lee SG, Park KM, Hwang S, et al. Adult-to-adult living donor liver transplantation at the Asan Medical Center, Korea [J]. Asian J Surg, 2002; 25(4): 277-284.
9.	Harihara Y, Makuuchi M, Kawarasaki H, et al. Initial experience with 40 cases of living-related donor liver transplantation at the University of Tokyo [J]. Transplant Proc, 1999; 31(7): 2893-2894.
10.	Furukawa H, Kishida A, Omura T, et al. Indication and strategy for adult living related liver transplantation [J]. Transplant Proc, 1999; 31(5): 1952.
11.	Kawasaki S, Makuuchi M, Matsunami H, et al. Living related liver transplantation in adults [J]. Ann Surg, 1998; 227(2): 269-274.
12.	Ben-Haim M, Emre S, Fishbein TM, et al. Critical graft size in adult-to-adult living donor liver transplantation: impact of the recipient’s disease [J]. Liver Transpl, 2001; 7(11): 948-953.
13.	Kiuchi T, Kasahara M, Uryuhara K, et al. Impact of graft size mismatching on graft prognosis in liver transplantation from living donors [J]. Transplantation, 1999; 67(2): 321-327.
14.	Thuluvath PJ, Yoo HY. Graft and patient survival after adult live donor liver transplantation compared to a matched cohort who received a deceased donor transplantation [J]. Liver Transpl, 2004; 10(10): 1263-1268.
15.	Lo CM, Fan ST, Chan JK, et al. Minimum graft volume for successful adult-to-adult living donor liver transplantation for fulminant hepatic failure [J]. Transplantation, 1996; 62(5): 696-698.
16.	Emond JC, Renz JF, Ferrell LD, et al. Functional analysis of grafts from living donors. Implications for the treatment of older recipients [J]. Ann Surg, 1996; 224(4): 544-552; discussion 552-554.
17.	Nakamura T, Tanaka K, Kiuchi T, et al. Anatomical variations and surgical strategies in right lobe living donor liver transplantation: lessons from 120 cases [J]. Transplantation, 2002; 73(12): 1896-1903.
18.	Ghobrial RM, Hsieh CB, Lerner S, et al. Technical challenges of hepatic venous outflow reconstruction in right lobe adult living donor liver transplantation [J]. Liver Transpl, 2001; 7(6): 551-555.
19.	Demetris AJ, Kelly DM, Eghtesad B, et al. Pathophysiologic observations and histopathologic recognition of the portal hyperperfusion or small-for-size syndrome [J]. Am J Surg Pathol, 2006; 30(8): 986-993.
20.	Lo CM, Liu CL, Fan ST. Portal hyperperfusion injury as the cause of primary nonfunction in a small-for-size liver graft-successful treatment with splenic artery ligation [J]. Liver Transpl, 2003; 9(6): 626-628.
21.	Perkins JD. Treatment of small-for-size syndrome [J]. Liver Transpl, 2008; 14(4): 571-572.
22.	嚴律南. 成人間活體肝移植的外科技術與創新 [J]. 中國普外基礎與臨床雜志， 2008； 15（3）： 151-154.
23.	Nishizaki T, Ikegami T, Hiroshige S, et al. Small graft for living donor liver transplantation [J]. Ann Surg, 2001; 233(4): 575-580.
24.	Cattral MS, Greig PD, Muradali D, et al. Reconstruction of middle hepatic vein of a living-donor right lobe liver graft with recipient left portal vein [J]. Transplantation, 2001; 71(12): 1864-1866.
25.	Ozden I, Kara M, Pinarbasi B, et al. Somatostatin and propranolol to treat small-for-size syndrome that occurred despite splenic artery ligation [J]. Exp Clin Transplant, 2007; 5(2): 686-689.
26.	Ito T, Kiuchi T, Yamamoto H, et al. Changes in portal venous pressure in the early phase after living donor liver transplantation: pathogenesis and clinical implications [J]. Transplantation, 2003; 75(8): 1313-1317.
27.	Troisi R, de Hemptinne B. Clinical relevance of adapting portal vein flow in living donor liver transplantation in adult patients [J]. Liver Transpl, 2003; 9(9): S36-S41.
28.	肖輝，王建. 脾切除術后再出血的診斷與防治 [J]. 中國普外基礎與臨床雜志， 2009； 16（12）： 1035-1036, 1041.

1. Tanaka K, Ogura Y. “Small-for-size graft” and “small-for-size syndrome” in living donor liver transplantation [J]. Yonsei Med J, 2004; 45(6): 1089-1094.
2. Heaton N. Small-for-size liver syndrome after auxiliary and split liver transplantation: donor selection [J]. Liver Transpl, 2003; 9(9): S26-S28.
3. Troisi R, Ricciardi S, Smeets P， et al. Effects of hemi-portocaval shunts for inflow modulation on the outcome of small-for-size grafts in living donor liver transplantation [J]. Am J Transplant, 2005; 5(6): 1397-1404.
4. Boillot O, Delafosse B, Méchet I, et al. Small-for-size partial liver graft in an adult recipient; a new transplant technique [J]. Lancet, 2002; 359(9304): 406-407.
5. Man K, Fan ST, Lo CM, et al. Graft injury in relation to graft size in right lobe live donor liver transplantation: a study of hepatic sinusoidal injury in correlation with portal hemodynamics and intragraft gene expression [J]. Ann Surg, 2003; 237(2): 256-264.
6. Ikegami T, Shimada M, Imura S, et al. Current concept of small-for-size grafts in living donor liver transplantation [J]. Surg Today, 2008; 38(11): 971-982.
7. Sanefuji K, Iguchi T, Ueda S, et al. New prediction factors of small-for-size syndrome in living donor adult liver transplantation for chronic liver disease [DB/OL]. Transpl Int. [Epub ahead of print]. http://www.ncbi.nlm.nih.gov/pubmed/ 19843295. Oct 19, 2009.
8. Lee SG, Park KM, Hwang S, et al. Adult-to-adult living donor liver transplantation at the Asan Medical Center, Korea [J]. Asian J Surg, 2002; 25(4): 277-284.
9. Harihara Y, Makuuchi M, Kawarasaki H, et al. Initial experience with 40 cases of living-related donor liver transplantation at the University of Tokyo [J]. Transplant Proc, 1999; 31(7): 2893-2894.
10. Furukawa H, Kishida A, Omura T, et al. Indication and strategy for adult living related liver transplantation [J]. Transplant Proc, 1999; 31(5): 1952.
11. Kawasaki S, Makuuchi M, Matsunami H, et al. Living related liver transplantation in adults [J]. Ann Surg, 1998; 227(2): 269-274.
12. Ben-Haim M, Emre S, Fishbein TM, et al. Critical graft size in adult-to-adult living donor liver transplantation: impact of the recipient’s disease [J]. Liver Transpl, 2001; 7(11): 948-953.
13. Kiuchi T, Kasahara M, Uryuhara K, et al. Impact of graft size mismatching on graft prognosis in liver transplantation from living donors [J]. Transplantation, 1999; 67(2): 321-327.
14. Thuluvath PJ, Yoo HY. Graft and patient survival after adult live donor liver transplantation compared to a matched cohort who received a deceased donor transplantation [J]. Liver Transpl, 2004; 10(10): 1263-1268.
15. Lo CM, Fan ST, Chan JK, et al. Minimum graft volume for successful adult-to-adult living donor liver transplantation for fulminant hepatic failure [J]. Transplantation, 1996; 62(5): 696-698.
16. Emond JC, Renz JF, Ferrell LD, et al. Functional analysis of grafts from living donors. Implications for the treatment of older recipients [J]. Ann Surg, 1996; 224(4): 544-552; discussion 552-554.
17. Nakamura T, Tanaka K, Kiuchi T, et al. Anatomical variations and surgical strategies in right lobe living donor liver transplantation: lessons from 120 cases [J]. Transplantation, 2002; 73(12): 1896-1903.
18. Ghobrial RM, Hsieh CB, Lerner S, et al. Technical challenges of hepatic venous outflow reconstruction in right lobe adult living donor liver transplantation [J]. Liver Transpl, 2001; 7(6): 551-555.
19. Demetris AJ, Kelly DM, Eghtesad B, et al. Pathophysiologic observations and histopathologic recognition of the portal hyperperfusion or small-for-size syndrome [J]. Am J Surg Pathol, 2006; 30(8): 986-993.
20. Lo CM, Liu CL, Fan ST. Portal hyperperfusion injury as the cause of primary nonfunction in a small-for-size liver graft-successful treatment with splenic artery ligation [J]. Liver Transpl, 2003; 9(6): 626-628.
21. Perkins JD. Treatment of small-for-size syndrome [J]. Liver Transpl, 2008; 14(4): 571-572.
22. 嚴律南. 成人間活體肝移植的外科技術與創新 [J]. 中國普外基礎與臨床雜志， 2008； 15（3）： 151-154.
23. Nishizaki T, Ikegami T, Hiroshige S, et al. Small graft for living donor liver transplantation [J]. Ann Surg, 2001; 233(4): 575-580.
24. Cattral MS, Greig PD, Muradali D, et al. Reconstruction of middle hepatic vein of a living-donor right lobe liver graft with recipient left portal vein [J]. Transplantation, 2001; 71(12): 1864-1866.
25. Ozden I, Kara M, Pinarbasi B, et al. Somatostatin and propranolol to treat small-for-size syndrome that occurred despite splenic artery ligation [J]. Exp Clin Transplant, 2007; 5(2): 686-689.
26. Ito T, Kiuchi T, Yamamoto H, et al. Changes in portal venous pressure in the early phase after living donor liver transplantation: pathogenesis and clinical implications [J]. Transplantation, 2003; 75(8): 1313-1317.
27. Troisi R, de Hemptinne B. Clinical relevance of adapting portal vein flow in living donor liver transplantation in adult patients [J]. Liver Transpl, 2003; 9(9): S36-S41.
28. 肖輝，王建. 脾切除術后再出血的診斷與防治 [J]. 中國普外基礎與臨床雜志， 2009； 16（12）： 1035-1036, 1041.

《中國普外基礎與臨床雜志》

術中監測及調整門靜脈血流預防活體肝移植術后小肝綜合征

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

《中國普外基礎與臨床雜志》

術中監測及調整門靜脈血流預防活體肝移植術后小肝綜合征

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料