Đánh giá kết quả tạo hình mạch máu trong phẫu thuật ghép gan phải từ người hiến sống và các yếu tố liên quan

Abstract

Objective: To evaluate of risk factors and outcomes of vascular reconstruction in right lobe graft living donor liver transplantation. Subject and method: The prospective study was performed on 52 cases of living donor liver transplantation using right lobe graft at 108 Military Central Hospital from January 2019 to December 2020. Result: There were 3 cases of middle hepatic vein obstruction (2 stenoses, 1 occlusion) (5.7%). The mortality rate of hepatic venous outflow obstruction was 1.9%. There were 5 cases of portal vein complications (9.6%). Portal vein stenosis was diagnosed and treated successfully by stent placement in 2 cases (3.8%). The remaining cases were due to recurrent thrombosis and compression by hematoma (5.8%), which were successfully managed conservatively. Hepatic artery stenosis was diagnosed and treated successfully by internal treatment in 1 case (1.9%). The rate of vascular complications was 17.2%. The overall survival time of the group of patients was 29.7 months. The survival rates were 88.5% at 6 months, 82.7% at 1 year, and 82.7% at 3 years. The caliber of HV anastomosis (< 30mm) was an independent risk factor for hepatic venous outflow obstruction. The size discrepancy between graft and recipient portal veins was an independent risk factor for portal vein stenosis. The hepatic artery diameter of graft < 2mm and hepatic artery dissection of recipient were independent risk factors for hepatic artery stenosis. Conclusion: The single orifice hepatic vein reconstruction in LDLT using a right lobe graft can prevent effectively HV stenosis. The stent placement is a safe and effective treatment for portal vein stenosis. The parachute technique of HA reconstruction under surgical loupes of magnification 3.5X is safe and effective.