切换至 "中华医学电子期刊资源库"

中华肝脏外科手术学电子杂志 ›› 2017, Vol. 06 ›› Issue (06) : 489 -493. doi: 10.3877/cma.j.issn.2095-3232.2017.06.016

所属专题: 文献

临床研究

CT血管造影在肝右叶活体肝移植术前供者肝静脉评估中价值
张亚琴1, 朱俊颖2, 吕海金3, 侯永和4, 孟晓春5,()   
  1. 1. 510900 广东省珠海市,中山大学附属第五医院放射科
    2. 510630 广州,中山大学附属第三医院放射科
    3. 510630 广州,中山大学附属第三医院外科ICU
    4. 510530 广州视源健康管理中心
    5. 510655 广州,中山大学附属第六医院放射科
  • 收稿日期:2017-09-13 出版日期:2017-12-10
  • 通信作者: 孟晓春
  • 基金资助:
    珠海市医疗卫生科技计划项目(20171009E030011)

Role of CT angiography in preoperative evaluation of donor hepatic veins before right lobe living donor liver transplantation

Yaqin Zhang1, Junying Zhu2, Haijin Lyu3, Yonghe Hou4, Xiaochun Meng5,()   

  1. 1. Department of Radiology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 510900, China
    2. Department of Radiology, Guangzhou 510630, China
    3. SICU, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
    4. CVTE Health Care Center, Guangzhou 510530, China
    5. Department of Radiology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China
  • Received:2017-09-13 Published:2017-12-10
  • Corresponding author: Xiaochun Meng
  • About author:
    Corresponding author: Meng Xiaochun, Email:
引用本文:

张亚琴, 朱俊颖, 吕海金, 侯永和, 孟晓春. CT血管造影在肝右叶活体肝移植术前供者肝静脉评估中价值[J]. 中华肝脏外科手术学电子杂志, 2017, 06(06): 489-493.

Yaqin Zhang, Junying Zhu, Haijin Lyu, Yonghe Hou, Xiaochun Meng. Role of CT angiography in preoperative evaluation of donor hepatic veins before right lobe living donor liver transplantation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2017, 06(06): 489-493.

目的

探讨CT血管造影(CTA)术前评价供者肝静脉分布及变异对肝右叶活体肝移植的临床意义。

方法

回顾性分析2007年5月至2016年4月在中山大学附属第三医院行肝右叶活体肝移植供肝捐献的40例供者临床资料。其中男37例,女3例;年龄18~57岁,中位年龄46岁。所有供者均签署知情同意书,符合医学伦理学规定。供者术前均以多平面重建(MPR)、3D最大密度投影(MIP)、容积再现(VR)显示肝中静脉(MHV)和肝右静脉(RHV)主干及分支。按Neumann分型将MHV分为1、2、3型,记录引流肝Ⅴ段和Ⅷ段粗大属支的管径与支数;按Nakamura分型将RHV分为A、B、C型,并记录管径>5 mm的副肝静脉支数。

结果

40例供者均顺利完成CTA,均清楚显示MHV和RHV。MHV的Neumann 1型占68%(27/40),2型12%(5/40),3型20%(8/40)。RHV的Nakamura A型占78%(31/40),B型12%(5/40),C型10%(4/40)。17例肝右叶副肝静脉直径>5 mm,其中A型者9例,B型者4例,C型者4例。21例供者进行了肝右叶活体肝移植供肝捐献,带MHV肝移植14例,不带MHV肝移植7例。手术证实术前CTA显示MHV、RHV的分型以及粗大肝右叶副肝静脉的支数与术中所见100%吻合。

结论

CTA血管造影能够清晰显示MHV、RHV及肝右叶副肝静脉解剖和变异并进行准确分型,为肝右叶活体肝移植术前决定MHV取舍提供详细的影像学解剖信息。

Objective

To investigate the clinical significance of CT angiography (CTA) in preoperative evaluation of the distribution and variation of donor hepatic veins before right lobe living donor liver transplantation.

Methods

Clinical data of 40 donors undergoing right lobe living donor liver transplantation in the Third Affiliated Hospital of Sun Yat-sen University between May 2007 and April 2016 were retrospectively analyzed. Among them, 37 donors were male and 3 were female, aged 18-57 years with a median age of 46 years. The informed consents of all donors were obtained and the local ethical committee approval was received. Before operation, the middle hepatic veins (MHV) and right hepatic veins (RHV) and branches of donors were evaluated by multiplanar reformation (MPR), 3D maximum intensity projection (MIP) and volume rendering (VR) techniques. According to the Neumann classification, MHV were divided into type 1, 2 and 3. The diameter and quantity of major drainage branch of liver segment Ⅴ and Ⅷ were measured. Based upon the Nakamura classification, RHV were divided into type A, B and C. The quantity of accessory hepatic veins with diameter >5 mm was measured.

Results

All 40 donors underwent CTA successfully. Both MHV and RHV were clearly displayed. The percentage of Neumann type 1 MHV was 68% (27/40), type 2 was 12% (5/40) and type 3 was 20% (8/40). The percentage of Nakamura type A RHV was 78% (31/40), type B was 12% (5/40) and type C was 10% (4/40). There were 17 donors with the diameter of accessory hepatic veins of right lobe >5 mm, including 9 cases of type A, 4 of type B and 4 of type C. Twenty-one donors underwent right lobe living donor liver transplantation, including 14 cases of liver transplantation with MHV, 7 cases of liver transplantation without MHV. Preoperative CTA evaluation of MHV and RHV classification, quantity of major accessory hepatic veins of right lobe was found 100% consistent with the intraoperative findings.

Conclusions

CTA can clearly display the MHV, RHV, anatomy, variation and classification of accessory hepatic veins of right lobe, which can provide detailed imaging and anatomical data for treating MHV during right lobe living donor liver transplantation.

图1 肝中静脉Neumann分型
[1]
Erbay N, Raptopoulos V, Pomfret EA, et al. Living donor liver transplantation in adults: vascular variants important in surgical planning for donors and recipients[J]. AJR Am J Roentgenol, 2003, 181(1):109-114.
[2]
Neumann JO, Thorn M, Fischer L, et al. Branching patterns and drainage territories of the middle hepatic vein in computer‐simulated right living‐donor hepatectomies[J]. Am J Transplant, 2006, 6(6):1407-1415.
[3]
Nakamura S, Tsuzuki T. Surgical anatomy of the hepatic veins and the inferior vena cava[J]. Surg Gynecol Obstet, 1981, 152(1):43-50.
[4]
Uchida K, Taniguchi M, Shimamura T, et al. Three‐dimensional computed tomography scan analysis of hepatic vasculatures in the donor liver for living donor liver transplantation[J]. Liver Transpl, 2010, 16(9):1062-1068.
[5]
朱志军,李俊杰,张建军,等.肝脏血管解剖与活体肝移植供者选择[J].中华器官移植杂志,2010,31(3):167-169.
[6]
Ito K, Akamatsu N, Tani K, et al. Reconstruction of hepatic venous tributary in right liver living donor liver transplantation: the importance of the inferior right hepatic vein[J]. Liver Transpl, 2016, 22(4):410-419.
[7]
Tani K, Shindoh J, Akamatsu N, et al. Venous drainage map of the liver for complex hepatobiliary surgery and liver transplantation[J]. HPB, 2016, 18(12):1031-1038.
[8]
Yang HR, Jeng LB, Li PC, et al. Living donor right hepatectomy with inclusion of the middle hepatic vein: outcome in 200 donors[J]. Transplant Proc, 2012, 44(2):460-462.
[9]
Brustia R, Komatsu S, Goumard C, et al. From the left to the right: 13-year experience in laparoscopic living donor liver transplantation[J]. Updates Surg, 2015, 67(2):193-200.
[10]
Duclos J, Bhangui P, Salloum C, et al. Ad integrum functional and volumetric recovery in right lobe living donors: is it really complete 1 year after donor hepatectomy?[J]. Am J Transplant, 2016, 16(1):143-156.
[11]
Lubezky N, Oyfe I, Contreras AG, et al. Segment 4 and the left lateral segment regeneration pattern after resection of the middle hepatic vein in a living donor right hepatectomy[J]. HPB, 2015, 17(1):72-78.
[12]
Everson GT, Hoefs JC, Niemann CU, et al. Functional elements associated with hepatic regeneration in living donors after right hepatic lobectomy[J]. Liver Transpl, 2013, 19(3):292-304.
[13]
Maetani Y, Itoh K, Egawa H, et al. Factors influencing liver regeneration following living-donor liver transplantation of the right hepatic lobe[J]. Transplantation, 2003, 75(1):97-102.
[14]
Kaido T, Ogawa K, Ogura Y, et al. Liver transplantation in adults with acute liver failure: a single center experience over a period of 15 years[J]. Hepatogastroenterology, 2015, 62(140):937-941.
[15]
Chan KM, Cheng CH, Wu TH, et al. Clinical strategy for the reconstruction of middle hepatic vein tributaries in right liver living donor liver transplantation[J]. World J Surg, 2014, 38(11):2927-2933.
[16]
Liu MC, Lin YT, Cheng SB, et al. Modified hepatic venous plane: a key factor for improving preoperative MDCT donor volume prediction in living-donor liver transplantation[J]. Transplant Proc, 2016, 48(8):2718-2725.
[17]
Thorat A, Hsu SC, Yang HR, et al. Reconstruction of isolated inferior right hepatic vein (s) in right lobe living donor liver transplantation using polytetrafluoroethylene grafts: a new feasible concept, technique of' bridging conduit venoplasty' and outcomes[J]. Ann Transplant, 2016(21):735-744.
[18]
Dayangac M, Taner CB, Balci D, et al. Use of middle hepatic vein in right lobe living donor liver transplantation[J]. Transpl Int, 2010, 23(3):285-291.
[1] . 肝移植治疗终末期肝病[J]. 中华危重症医学杂志(电子版), 2023, 16(04): 1-.
[2] 李坤河, 寇萌佳, 邝立挺. 肝移植术后二次气管插管的危险因素及预测模型的建立[J]. 中华普通外科学文献(电子版), 2023, 17(05): 366-371.
[3] 中华医学会器官移植学分会, 中国医师协会器官移植医师分会, 上海医药行业协会. 中国肝、肾移植受者霉酚酸类药物应用专家共识(2023版)[J]. 中华移植杂志(电子版), 2023, 17(05): 257-272.
[4] 陆闻青, 陈昕怡, 任雪飞. 遗传代谢病儿童肝移植受者术后生活质量调查研究[J]. 中华移植杂志(电子版), 2023, 17(05): 287-292.
[5] 范铁艳, 李君, 陈虹. 肝移植术后新发戊型病毒性肝炎的诊治经验[J]. 中华移植杂志(电子版), 2023, 17(05): 293-296.
[6] 陈朔, 陈峰, 程飞, 项捷. 糖原累积病Ⅰ型并发胰腺炎肝移植术后胰腺梗死一例[J]. 中华移植杂志(电子版), 2023, 17(05): 300-302.
[7] 汤鹏昊, 张武. 肠道微生态与肝移植围手术期并发症相关研究进展[J]. 中华移植杂志(电子版), 2023, 17(05): 303-307.
[8] 祝丽娜, 杨子祯, 张迪, 张勇, 蔡金贞, 王建红. 超声造影在肝移植术后肝动脉并发症中的应用价值[J]. 中华移植杂志(电子版), 2023, 17(04): 240-245.
[9] 严庆, 刘颖, 邓斐文, 陈焕伟. 微血管侵犯对肝癌肝移植患者生存预后的影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 624-629.
[10] 廖梅, 张红君, 金洁玚, 吕艳, 任杰. 床旁超声造影对肝移植术后早期肝动脉血栓的诊断价值[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 630-634.
[11] 李秉林, 吕少诚, 潘飞, 姜涛, 樊华, 寇建涛, 贺强, 郎韧. 供肝灌注液病原菌与肝移植术后早期感染的相关性分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 656-660.
[12] 吕垒, 冯啸, 何凯明, 曾凯宁, 杨卿, 吕海金, 易慧敏, 易述红, 杨扬, 傅斌生. 改良金氏评分在儿童肝豆状核变性急性肝衰竭肝移植手术时机评估中价值并文献复习[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 661-668.
[13] 王孟龙. 肿瘤生物学特征在肝癌肝移植治疗中的意义[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 490-494.
[14] 王晓东, 汪恺, 葛昭, 丁忠祥, 徐骁. 计算机视觉技术在肝癌肝移植疗效提升中的研究进展[J]. 中华肝脏外科手术学电子杂志, 2023, 12(04): 361-366.
[15] 雷永琪, 刘新阳, 俞星新, 耿志达, 刘雨, 陈政良, 梁英健. 腹腔镜肝切除术中意外研判与决策[J]. 中华肝脏外科手术学电子杂志, 2023, 12(04): 372-375.
阅读次数
全文


摘要