Kỹ thuật tạo hình mạch máu trong phẫu thuật ghép gan phải từ người hiến sống

Abstract

Objective: To evaluate the technical characteristics 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 42 cases of using the extended lobe living donor liver transplant including the middle hepatic vein (80.7%) and 10 cases of the modified right lobe graft with the middle hepatic vein reconstructed from the V5 and/or V8 branches (19.3%) by using polytetrafluoroethylene artificial vessels. We conjoined the MHV and RHV as a single orifice hepatic vein. The hepatic veins were enlarged to the left and downwards at the orifice of the recipient's right hepatic vein, with a mean incision length of 14mm and 9.7mm, respectively. A total of 15 accessory right inferior hepatic veins with diameter > 5mm were anastomosed directly to inferior vena cava (IVC) in an end-to-side fashion in recipient (28.8%). 100% of the portal vein anatomical anastomosis were performed in an end-to-end fashion using continuous sutures. The thrombectomy was performed in 4 cases of PVT grade I and II. Two cases were performed simultaneous splenectomy during LDLT, and five cases underwent portosystemic collaterals ligation. 100% of the hepatic arteries anatomical reconstructions were performed under surgical loupes of magnification 3.5X in an end-to-end fashion with parachute technique using continuous 8-0 Prolene sutures. A total of 2 cases with mild intimal dissection need to cut back the dissected artery to get a healthy undissected stump (3.8%) and 2 cases need to use the other undissected HA (3.8%). Conclusion: The single orifice hepatic vein reconstruction in LDLT using a right lobe graft is a feasible surgical technique. It is necessary to assess the anatomical variation, non-tumoral thrombosis of the portal vein and the intimal dissection of  hepatic artery before transplantation to select the most appropriate reconstruction method.