Медицинская литература. Новинки

 

 

 

 

 

 

Эфферентное кровоснабжение правой доли печени в аспекте ее трансплантации от живого донора: вариантная анатомия, классификация. Часть 1

Вы можете загрузить полный текст статьи в формате pdf

Цель. Описание новых и дополнение имеющихся сведений об анатомических особенностях строения печеночных вен у донора правой доли печени, формулировка принципов подбора доноров, исходя из сосудистой анатомии. Материал и методы. В ФГБУ ГНЦ ФМБЦ им. А.И. Бурназяна с 2009 по 2021 г. проведено 306 трансплантаций печени от живого родственного донора. Анализировали сосудистую анатомию 518 потенциальных доноров. Провели оценку распространенности разных вариантов строения вен правой доли печени. Результаты. Выявлено 14 подтипов анатомии эфферентных сосудов. Их классифицировали в 3 типа в зависимости от вклада срединной вены в отток крови от правой доли печени: кавальный (67,3%), кава-срединный (полусепаратный, 29%) и сепаратный (3,6%). Заключение. Анатомия эфферентных сосудов трансплантата правой доли печени отличается вариабельностью и сложностью. Это требует точной оценки на дооперационном этапе при КТ для обеспечения готовности к реконструкции любой сложности.

Ключевые слова:
печень, родственная трансплантация, анатомия, печеночные вены, реконструкция, классификация

Литература:
1. Восканян С.Э., Артемьев А.И., Найденов Е.В., Колышев И.Ю., Забежинский Д.А., Шабалин М.В., Башков А.Н., Григорьева О.О., Щербин В.В., Журбин А.С. ALPPS в преодолении малого остаточного объема печени при альвеококкозе. Анналы хирургической гепатологии. 2018; 23 (4): 21–32. https://doi.org/10.16931/1995­5464.2018421­32
Voskanyan S.E., Artemiev A.I., Naydenov E.V., Kolyshev I.Yu., Zabezhinsky D.A., Shabalin M.V., Bashkov A.N., Grigorieva O.O., Shcherbin V.V., Zhurbin A.S. ALPPS in overcoming small remnant liver volume in alveolar echinococcosis. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2018; 23 (4): 21–32. https://doi.org/10.16931/1995­5464.2018421­32 (In Russian)
2. Готье С.В., Монахов А.Р., Цирульникова О.М., Зубенко С.И., Ситникова Е.В., Умрик Д.В., Носов К.А., Куртак Н.Д. Результаты трансплантации печени при гепатоцеллюлярном раке: опыт одного центра. Анналы хирургической гепатологии. 2020; 25 (2): 67–76. https://doi.org/10.16931/1995­5464.2020267­76
Gautier S.V., Monakhov A.R., Tsirulnikova O.M., Zubenko S.I., Sitnikova E.V., Umrik D.V., Nosov K.A., Kurtak N.D. Outcomes of liver transplantation in hepatocellular carcinoma: a single­center experience. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2020; 25 (2): 67–76. https://doi.org/10.16931/1995­5464.2020267­76 (In Russian)
3. Tran M.L., Humar A. Expanding living donor liver transplantation in the Western world: changing the paradigm. Dig. Med. Res. 2020; 3. https://doi.org/10.21037/dmr­20­87
4. Rela M., Reddy M.S. Living donor liver transplant (LDLT) is the way forward in Asia. Hepatol. Int. 2017; 11 (2): 148–151. https://doi.org/10.1007/s12072­016­9780­z
5. Goldaracena N., Barbas A.S. Living donor liver transplantation. Curr. Opin. Organ Transplant. 2019; 24 (2): 131–137. https://doi.org/10.1097/MOT.0000000000000610
6. Brown R.S. Jr., Russo M.W., Lai M., Shiffman M.L., Richardson M.C., Everhart J.E., Hoofnagle J.H. A survey of liver transplantation from living adult donors in the United States. N. Engl. J. Med. 2003; 348 (9): 818–825. https://doi.org/10.1056/NEJMsa021345
7. Nakamura T., Tanaka K., Kiuchi T., Kasahara M., Oike F., Ueda M., Kaihara S., Egawa H., Ozden I., Kobayashi N., Uemoto S. Anatomical variations and surgical strategies in right lobe living donor liver transplantation: lessons from 120 cases. Transplantation. 2002; 73 (12): 1896–1903. https://doi.org/10.1097/00007890­200206270­00008
8. Soyer P., Bluemke D.A., Choti M.A., Fishman E.K. Variations in the intrahepatic portions of the hepatic and portal veins: findings on helical CT scans during arterial portography. AJR Am. J. Roentgenol. 1995; 164 (1): 103–108. https://doi.org/10.2214/ajr.164.1.7998521
9. Orguc S., Tercan M., Bozoklar A., Akyildiz M., Gurgan U., Celebi A., Nart D., Karasu Z., Icoz G., Zeytunlu M., Yuzer Y., Tokat Y., Kilic M. Variations of hepatic veins: helical computerized tomography experience in 100 consecutive living liver donors with emphasis on right lobe. Transplant. Proc. 2004; 36 (9): 2727–2732. https://doi.org/10.1016/j.transproceed.2004.10.006
10. Hirai I., Kimura W., Fuse A., Yamamoto T., Moriya T., Mizutani M. Evaluation of inferior right hepatic vein­preserving hepatectomy with resection of the superior right hepatic vein. Hepatogastroenterology. 2006; 53 (70): 516–250. PMID: 16995452
11. Varotti G., Gondolesi G.E., Goldman J., Wayne M., Flor­man S.S., Schwartz M.E., Miller C.M., Sukru E. Anatomic variations in right liver living donors. J. Am. Coll. Surg. 2004; 198 (4): 577–582. https://doi.org/10.1016/j.jamcollsurg.2003.11.014
12. Tan C.H.N., Hwang S., Bonney G.K., Ganpathi I.S., Madhavan K., Kow W.C.A. The influence of the middle hepatic vein and its impact on outcomes in right lobe living donor liver transplantation. HPB (Oxford). 2019; 21 (5): 547–556. https://doi.org/10.1016/j.hpb.2018.09.003
13. Guo H.J., Wang K., Chen K.C., Liu Z.K., Al­Ameri A., Shen Y., Xu X., Zheng S.S. Middle hepatic vein reconstruction in adult right lobe living donor liver transplantation improves recipient survival. Hepatobiliary Pancreat. Dis. Int. 2019; 18 (2): 125–131. https://doi.org/10.1016/j.hbpd.2019.01.006
14. De Cecchis L., Hribernik M., Ravnik D., Gadzijev E.M. Anatomical variations in the pattern of the right hepatic veins: possibilities for type classification. J. Anat. 2000; 197 Pt 3 (Pt 3): 487–493. https://doi.org/10.1046/j.1469­7580.2000.19730487.x
15. Radtke A., Schroeder T., Sotiropoulos G.C., Molmenti E., Schenk A., Paul A., Nadalin S., Lang H., Saner F., Peitgen H.O., Broelsch C.E., Malago M. Anatomical and physiological classification of hepatic vein dominance applied to liver transplantation. Eur. J. Med. Res. 2005; 10 (5): 187–194. PMID: 15946917
16. Inomata Y., Uemoto S., Asonuma K., Egawa H. Right lobe graft in living donor liver transplantation. Transplantation. 2000; 69 (2): 258–264. https://doi.org/10.1097/00007890­200001270­00011
17. Ito K., Akamatsu N., Tani K., Ito D., Kaneko J., Arita J., Sakamoto Y., Hasegawa K., Kokudo N. Reconstruction of hepatic venous tributary in right liver living donor liver transplantation: the importance of the inferior right hepatic vein. Liver Transpl. 2016; 22 (4): 410–419. https://doi.org/10.1002/lt.24386
18. Hwang S., Ahn C.S., Kim K.H., Moon D.B., Ha T.Y., Song G.W., Jung D.H., Park G.C., Namgoong J.M., Yoon S.Y., Jung S.W., Lee S.G. Standardization of modified right lobe grafts to minimize vascular outflow complications for adult living donor liver transplantation. Transplant. Proc. 2012; 44 (2): 457–459. https://doi.org/10.1016/j.transproceed.2012.01.072
19. Hwang S., Lee S.G., Ahn C.S., Moon D.B., Kim K.H., Sung K.B., Ko G.Y., Ha T.Y., Song G.W., Jung D.H., Gwon D.I., Kim K.W., Choi N.K., Kim K.W., Yu Y.D., Park G.C. Morphometric and simulation analyses of right hepatic vein reconstruction in adult living donor liver transplantation using right lobe grafts. Liver Transpl. 2010; 16 (5): 639–648. https://doi.org/10.1002/lt.22045
20. Ko G.Y., Sung K.B., Yoon H.K., Kim K.R., Kim J.H., Gwon D.I., Lee S.G. Early posttransplant hepatic venous outflow obstruction: long­term efficacy of primary stent placement. Liver Transpl. 2008; 14 (10): 1505–1511. https://doi.org/10.1002/lt.21560
21. Gyu Lee S., Min Park K., Hwang S., Hun Kim K., Nak Choi D., Hyung Joo S., Soo Anh C., Won Nah Y., Yeong Jeon J., Hoon Park S., Suck Koh K., Hoon Han S., Taek Choi K., Sam Hwang K., Sugawara Y., Makuuchi M., Chul Min P. Modified right liver graft from a living donor to prevent congestion. Transplantation. 2002; 74 (1): 54–59. https://doi.org/10.1097/00007890­200207150­00010
22. Jeng L.B., Thorat A., Yang H.R., Li P.C. Venous outflow reconstruction in living donor liver transplantation: dealing with venous anomalies. World J. Transplant. 2015; 5 (4): 145–153. https://doi.org/10.5500/wjt.v5.i4.145

Efferent blood supply to the right hepatic lobe regarding its transplantation from a living donor: variant anatomy, classification. Part 1

Aim. To describe new data and to complement the existing information about the anatomic features of the hepatic vein structure in the donor of the right hepatic lobe, to formulate the principles of donor selection proceeding from vascular anatomy. Materials and methods. 306 liver transplantations from living related donors were performed at A.I. Burnazyan Federal Medical Biophysical Center of Federal Medical and Biological Agency of Russia from 2009 to 2021. The vascular anatomy of 518 potential donors was analyzed. The prevalence of different vein structures of the right hepatic lobe was assessed. Results. The authors identified 14 subtypes of anatomy of efferent vessels. They were classified into 3 types depending on the contribution of the median vein to the blood outflow from the right hepatic lobe: caval (67.3%), cava medial (semi-separate, 29%), and separate (3.6%). Conclusion. The anatomy of the efferent vessels of the right lobe graft is characterized by variability and complexity. It requires accurate assessment at the preoperative stage (CT scanning) to be ready for reconstruction of any complexity.

Keywords:
liver, related transplantation, anatomy, hepatic veins, reconstruction, classification