- 作者：Takanori Sakaguchi ; Shohachi Suzuki ; Keisuke Inaba ; Kazuhiko Fukumoto ; Yasuo Takehara ; Hatsuko Nasu ; Mika Kamiya ; Shuhei Yamashita ; Takasuke Ushio ; Satoshi Nakamura ; Hiroyuki Konno
- 刊名：Surgery
- 出版年：2010
- 出版时间：June 2010
- 年：2010
- 卷：147
- 期：6
- 页码：805-810
- 全文大小：429 K
Background
The necessity of preserving hepatic venous drainage in hepatectomy and liver transplantation has recently been accepted; however, the hepatic vein (HV) can be removed when an effective intrahepatic venovenous shunt (VV shunt) exists.Methods
Occlusion venography of the right HV (RHV) was performed in 51 patients to investigate the VV shunt characteristics.
Results
Twenty patients had a shunt between the RHV and large HVs whose root diameters were >3 mm, such as the superficial or inferior RHV, or the middle HV. Twenty patients had a shunt between the RHV and small HVs with root diameters ≤3 mm. Eleven patients had no shunt. The change in anterior portal vein blood flow after RHV occlusion, evaluated by Doppler ultrasonography, was minimal (5 ± 3 % ) in patients with a shunt between the RHV and large HVs, and less than in patients with a shunt between the RHV and small HVs (38 % ± 18 % ) or without a shunt (50 % ± 17 % ; P < .0001). A shunt between the RHV and large HV was less frequently seen in those patients with cirrhosis (3/20) than in those without cirrhosis (17/31; P = .0044). The existence of the shunt between the RHV and large HVs was unpredictable, however, from computed tomographic findings or laboratory data.
Conclusion
A hemodynamically significant VV shunt between the RHV and large HV was observed in fewer than half of the patients and less frequently in cirrhotic patients. Preservation of hepatic venous drainage should be considered in patients without a hemodynamically significant VV shunt in liver surgery.