• 1.上海交通大學(xué)醫(yī)學(xué)院附屬瑞金醫(yī)院普外科器官移植中心（上海 200025）;;
  • 2.上海交通大學(xué)醫(yī)學(xué)院附屬瑞金醫(yī)院放射科（上海 200025）;

目的 分析供體肝中葉靜脈回流類型，探討其對(duì)移植物選擇的指導(dǎo)意義。
方法 回顧性分析2005年4月至2009年3月期間，在瑞金醫(yī)院器官移植中心參加活體肝移植供體篩選的109例潛在供體的CT檢查資料，根據(jù)Marcos分型和Nakamura分型分別分析供體肝中靜脈回流類型和Ⅳb段靜脈回流類型。
結(jié)果 本組供體的肝中靜脈按其兩側(cè)分支的不同可分為3型，其中Ⅰ、Ⅱ型相對(duì)較多，分別占44.0%（48/109）、37.6%（41/109），Ⅲ型最少，占18.3%（20/109）。各型供體的全肝體積、左半肝體積、左半肝體積占全肝比例等的差異均無統(tǒng)計(jì)學(xué)意義（P gt;0.05）。Ⅳb段靜脈則以Ⅰ型最多，占72.5%（79/109），Ⅱ、Ⅲ型較少，分別占12.8%（14/109）及14.7%（16/109）。最終有37例供體捐出右半肝,其中MarcosⅠ、Ⅱ及Ⅲ型供體保留肝中靜脈者分別占12/17、8/11及5/9,NakamuraⅠ、Ⅱ及Ⅲ型供體保留肝中靜脈者則分別占16/26、4/6及5/5。
結(jié)論 成人間活體肝移植切取右半肝移植物時(shí)，Marcos分型和Nakamura分型結(jié)果對(duì)肝中靜脈的取舍可能有重要意義。

引用本文： 陳擁軍,沈柏用,陳皓,詹茜,李衛(wèi)俠,李宏為,彭承宏. 成人間活體肝移植供體肝中葉靜脈回流類型與移植物的選擇. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(5): 420-424. doi: 復(fù)制

1. Ichida T, Matsunami H, Kawasaki S, et al. Living related-donor liver transplantation from adult to adult for primary biliary cirrhosis [J]. Ann Intern Med, 1995; 122(4): 275-276.
2. Lo CM, Fan ST, Liu CL, et al. Extending the limit on the size of adult recipient in living donor liver transplantation using extended right lobe graft [J]. Transplantation, 1997; 63(10): 1524-1528.
3. Fujita S, Kim ID, Uryuhara K, et al. Hepatic grafts from live donors: donor morbidity for 470 cases of live donation [J]. Transpl Int, 2000; 13(5): 333-339.
4. Abecassis M, Adams M, Adams P, et al. Live Organ Donor Consensus Group. Consensus statement on the live organ donor [J]. JAMA, 2000; 284(22): 2919-2926.
5. Fan ST. Live donor liver transplantation in adults [J]. Tr-ansplantation, 2006; 82(6): 723-732.
6. Trotter JF, Wachs M, Everson GT, et al. Adult-to-adult transplantation of the right hepatic lobe from a living donor [J]. N Engl J Med, 2002; 346(14): 1074-1082.
7. Inomata Y, Uemoto S, Asonuma K, et al. Right lobe graft in living donor liver transplantation [J]. Transplantation, 2000; 69(2): 258-264.
8. 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.
9. Kido M, Ku Y, Fukumoto T, et al. Significant role of middle hepatic vein in remnant liver regeneration of right-lobe living donors [J]. Transplantation, 2003; 75(9): 1598-1600.
10. 李衛(wèi)俠， 林曉珠， 柴維敏， 等. 多層螺旋CT測(cè)量肝臟體積的準(zhǔn)確性 [J]. 中華放射學(xué)雜志， 2008; 42(5): 460-463.
11. 李衛(wèi)俠， 林曉珠， 柴維敏， 等. MSCT肝臟體積測(cè)量研究 [J]. 臨床放射學(xué)雜志， 2008; 27(11): 1512-1515.
12. 方馳華， 吳東波， 黃燕鵬， 等. 螺旋CT掃描數(shù)據(jù)的虛擬輔助性部分原位肝移植手術(shù) [J]. 中國普外基礎(chǔ)與臨床雜志， 2008; 15(10): 729-732.
13. Marcos A, Orloff M, Mieles L, et al. Functional venous anatomy for right-lobe grafting and techniques to optimize outflow [J]. Liver Transpl, 2001; 7(10): 845-852.
14. Nakamura S, Tsuzuki T. Surgical anatomy of the hepatic veins and the inferior vena cava [J]. Surg Gynecol Obstet, 1981; 152(1): 43-50.
15. 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.
16. Sugawara Y, Makuuchi M, Sano K, et al. Vein reconstruction in modified right liver graft for living donor liver transplantation [J]. Ann Surg, 2003; 237(2): 180-185.
17. Radtke A, Nadalin S, Sotiropoulos GC, et al. Computer-assisted operative planning in adult living donor liver transplantation: a new way to resolve the dilemma of the middle hepatic vein [J]. World J Surg, 2007; 31(1): 175-185.
18. Kaneko T, Sugimoto H, Hirota M, et al. Intrahepatic venous anastomosis formation of the right liver in living donor liver transplantation: evaluations by Doppler ultrasonography and pulse-inversion ultrasonography with Levovist [J]. Surgery, 2005; 138(1): 21-27.
19. Fan ST, Lo CM, Liu CL, et al. Safety and necessity of including the middle hepatic vein in the right lobe graft in adult-to-adult live donor liver transplantation [J]. Ann Surg, 2003; 238(1): 137-148.
20. 黃潔夫. 我國活體供肝肝移植發(fā)展面臨的挑戰(zhàn)和應(yīng)對(duì)措施 [J]. 中華外科雜志, 2008; 46(3): 161-162.
21. Li FG, Yan LN, Zeng Y, et al. Donor safety in adult living donor liver transplantation using the right lobe: single center experience in China [J]. World J Gastroenterol, 2007; 13(27): 3752-3755.
22. Shin JH, Sung KB, Yoon HK, et al. Endovascular stent placement for interposed middle hepatic vein graft occlusion after living-donor liver transplantation using right-lobe graft [J]. Liver Transpl, 2006; 12(2): 269-276.
23. Lo CM, Fan ST, Liu CL, et al. Hepatic venoplasty in living-donor liver transplantation using right lobe graft with middle hepatic vein [J]. Transplantation, 2003; 75(3): 358-360.
24. 陳擁軍， 彭承宏， 沈柏用， 等. 成人間活體肝移植供體行改良擴(kuò)大右半肝切除的安全性 [J]. 外科理論與實(shí)踐， 2008； 13(4): 316-321.
25. Hwang S, Lee SG, Choi ST, et al. Hepatic vein anatomy of the medial segment for living donor liver transplantation using extended right lobe graft [J]. Liver Transpl， 2005; 11(4): 449-455.
26. Chan SC, Lo CM, Liu CL, et al. Tailoring donor hepatectomy per segment 4 venous drainage in right lobe live donor liver transplantation [J]. Liver Transpl， 2004; 10(6): 755-762.
  1. 1. Ichida T, Matsunami H, Kawasaki S, et al. Living related-donor liver transplantation from adult to adult for primary biliary cirrhosis [J]. Ann Intern Med, 1995; 122(4): 275-276.
  2. 2. Lo CM, Fan ST, Liu CL, et al. Extending the limit on the size of adult recipient in living donor liver transplantation using extended right lobe graft [J]. Transplantation, 1997; 63(10): 1524-1528.
  3. 3. Fujita S, Kim ID, Uryuhara K, et al. Hepatic grafts from live donors: donor morbidity for 470 cases of live donation [J]. Transpl Int, 2000; 13(5): 333-339.
  4. 4. Abecassis M, Adams M, Adams P, et al. Live Organ Donor Consensus Group. Consensus statement on the live organ donor [J]. JAMA, 2000; 284(22): 2919-2926.
  5. 5. Fan ST. Live donor liver transplantation in adults [J]. Tr-ansplantation, 2006; 82(6): 723-732.
  6. 6. Trotter JF, Wachs M, Everson GT, et al. Adult-to-adult transplantation of the right hepatic lobe from a living donor [J]. N Engl J Med, 2002; 346(14): 1074-1082.
  7. 7. Inomata Y, Uemoto S, Asonuma K, et al. Right lobe graft in living donor liver transplantation [J]. Transplantation, 2000; 69(2): 258-264.
  8. 8. 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.
  9. 9. Kido M, Ku Y, Fukumoto T, et al. Significant role of middle hepatic vein in remnant liver regeneration of right-lobe living donors [J]. Transplantation, 2003; 75(9): 1598-1600.
  10. 10. 李衛(wèi)俠， 林曉珠， 柴維敏， 等. 多層螺旋CT測(cè)量肝臟體積的準(zhǔn)確性 [J]. 中華放射學(xué)雜志， 2008; 42(5): 460-463.
  11. 11. 李衛(wèi)俠， 林曉珠， 柴維敏， 等. MSCT肝臟體積測(cè)量研究 [J]. 臨床放射學(xué)雜志， 2008; 27(11): 1512-1515.
  12. 12. 方馳華， 吳東波， 黃燕鵬， 等. 螺旋CT掃描數(shù)據(jù)的虛擬輔助性部分原位肝移植手術(shù) [J]. 中國普外基礎(chǔ)與臨床雜志， 2008; 15(10): 729-732.
  13. 13. Marcos A, Orloff M, Mieles L, et al. Functional venous anatomy for right-lobe grafting and techniques to optimize outflow [J]. Liver Transpl, 2001; 7(10): 845-852.
  14. 14. Nakamura S, Tsuzuki T. Surgical anatomy of the hepatic veins and the inferior vena cava [J]. Surg Gynecol Obstet, 1981; 152(1): 43-50.
  15. 15. 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.
  16. 16. Sugawara Y, Makuuchi M, Sano K, et al. Vein reconstruction in modified right liver graft for living donor liver transplantation [J]. Ann Surg, 2003; 237(2): 180-185.
  17. 17. Radtke A, Nadalin S, Sotiropoulos GC, et al. Computer-assisted operative planning in adult living donor liver transplantation: a new way to resolve the dilemma of the middle hepatic vein [J]. World J Surg, 2007; 31(1): 175-185.
  18. 18. Kaneko T, Sugimoto H, Hirota M, et al. Intrahepatic venous anastomosis formation of the right liver in living donor liver transplantation: evaluations by Doppler ultrasonography and pulse-inversion ultrasonography with Levovist [J]. Surgery, 2005; 138(1): 21-27.
  19. 19. Fan ST, Lo CM, Liu CL, et al. Safety and necessity of including the middle hepatic vein in the right lobe graft in adult-to-adult live donor liver transplantation [J]. Ann Surg, 2003; 238(1): 137-148.
  20. 20. 黃潔夫. 我國活體供肝肝移植發(fā)展面臨的挑戰(zhàn)和應(yīng)對(duì)措施 [J]. 中華外科雜志, 2008; 46(3): 161-162.
  21. 21. Li FG, Yan LN, Zeng Y, et al. Donor safety in adult living donor liver transplantation using the right lobe: single center experience in China [J]. World J Gastroenterol, 2007; 13(27): 3752-3755.
  22. 22. Shin JH, Sung KB, Yoon HK, et al. Endovascular stent placement for interposed middle hepatic vein graft occlusion after living-donor liver transplantation using right-lobe graft [J]. Liver Transpl, 2006; 12(2): 269-276.
  23. 23. Lo CM, Fan ST, Liu CL, et al. Hepatic venoplasty in living-donor liver transplantation using right lobe graft with middle hepatic vein [J]. Transplantation, 2003; 75(3): 358-360.
  24. 24. 陳擁軍， 彭承宏， 沈柏用， 等. 成人間活體肝移植供體行改良擴(kuò)大右半肝切除的安全性 [J]. 外科理論與實(shí)踐， 2008； 13(4): 316-321.
  25. 25. Hwang S, Lee SG, Choi ST, et al. Hepatic vein anatomy of the medial segment for living donor liver transplantation using extended right lobe graft [J]. Liver Transpl， 2005; 11(4): 449-455.
  26. 26. Chan SC, Lo CM, Liu CL, et al. Tailoring donor hepatectomy per segment 4 venous drainage in right lobe live donor liver transplantation [J]. Liver Transpl， 2004; 10(6): 755-762.