Abstract:

Objective To summarize the experiences of back-stage procedures for living donor liver graft，and to provide the experience of liver transplantation. Methods The data from 230 cases of back-stage proceduresof living donor graft in Tianjin First Center Hospital from September 2006 to May 2009 were reprospectivelyreviewed. Results A total of 230 grafts were harvested．Graft type included ：right liver graft with the middle hepatic vein in 117 cases，the inferior right hepatic vein（IRHV）was reconstructed in 5 out of 117 cases，with partial middle hepatic vein in 3 cases ；right liver graft without the middle hepatic vein in 102 cases，the IRHV wasreconstructed in 16 out of 102 cases ；left liver graft with the middle hepatic vein and caudate in 3 cases ；left lateral lobe in 2 cases. There was significant difference between two group（P ＝ 0.045）. In 102 cases of right liver graft without the middle hepatic vein ：right hepatic vein（RHV）in 11 case，RHV+ IRHV in 6 cases，RHV+V5/8 in 71cases，RHV+V5/8+IRHV in 10 cases，V5/8 in 81 cases. In some cases different materials were used to reconstructthe hepatic vein ：including cold-storage cadaveric iliac veins in 77 cases，great saphenous vein in 1 case，varicose umbililical vein in 1 case，recipient intrahepatic portal vein in 1 case and recipient intrahepatic vein in 1 case. Amongthe 222 right grafts，type C portal vein was identified in 9 cases and venoplasty was performed to incorporate 2 portal veins into a single orifice．1 case of type D was venoplastied into one orifice with iliac vein. There were 226 caseswith single hepatic artery and 4 cases with two hepatic artery. Conclusion The venoplasty and reconstruction of donor graft hepatic artery，portal vein and outflow in the protection of preservation solution can simplify implanted procedure，preserve hepatic function and it is important for postoperative recovering of the recipients．

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摘要：

目的 报告活体肝移植供肝后台的修整经验，为肝移植手术的成功提供依据。方法 回顾 分析天津市第一中心医院 2006 年 9 月至 2009 年 5 月间完成的 230 例活体肝移植供肝后台准备的资料。结果 230 例供肝中 ：含肝中静脉右半肝 117 例 ；含部分肝中静脉 3 例 ；不含肝中静脉右半肝 102 例 ；含肝中静脉及尾状叶的左半肝 3 例 ；左外侧叶 5 例。102 例不含肝中静脉右半肝重建肝右后下静脉（IRHV）5 例， 117 例含肝中静脉右半肝重建 IRHV 16 例，两组间存在显著差异（P ＝ 0.045）。102 例不含肝中静脉的右半肝中 ：11 例肝右静脉（RHV），6 例 RHV+IRHV，75 例 RHV+V5/8，10 例 RHV+V5/8+IRHV。81 例 V5/8 采用不同材料重建静脉 ：新鲜尸体髂静脉 77 例，受体大隐静脉 1 例，受体曲张脐静脉 1 例，受体肝内门静脉1 例，受体肝静脉 1 例。222 例右半肝供肝中门静脉为 C 型的 9 例，均成型为一个开口，D 型 1 例采用髂血管成型为一支。肝动脉单支者 226 例，双支者为 4 例，2 例采用动脉重建。结论 活体肝移植供肝后台修整在供肝灌洗保存的同时，对供体的肝动脉、门静脉及流出道恰当的成型或重建有利于简化供肝植入的步骤，保护肝脏的功能组织，是手术成功的关键。

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