Preliminary Study On Application Value Of Segment Ⅳ Portal Vein Reconstruction In Split Liver Transplantation For Early Postoperative Recovery Of Liver Function

Objective:To explore the significance of IV portal vein reconstruction of donor liver in split liver transplantation for early postoperative liver function recovery,and to provide theoretical basis for further improvement of surgical methods.Methods: A retrospective analysis of 19 recipients with split liver transplantation from the Organ Transplantation Center of the Affiliated Hospital of Qingdao University from January 1st,2015 to January 31 st,2021 was conducted.Two groups were divided according to whether IV portal vein reconstruction was performed.No portal vein reconstruction was performed in 6 patients(control group).Portal vein reconstruction was performed in 13 patients(reconstruction group).Alanine Aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),gamma-glutamyltransferase(GGT),Total bilirubin(TB),Direct bilirubin(DB),lactic acid(lac)levels were observed before surgery,1 day after surgery,3 days after surgery,7 days after surgery,14 days after surgery,and 30 days after surgery.Statistical software in R language was used for data processing.Normal distribution measurement data were expressed as mean±standard deviation,and independent samples were compared between reconstruction group and control group by T-test.Non-normal distribution measurement data are represented by the median.Data with P value less than 0.05 were considered to have statistical difference.Results: Among the observed indicators of recipients,ALT,AST,ALP,GGT,TB,DB and lac levels were compared between the reconstruction group and the control group at before surgery,1 day after surgery,3 days after surgery,7 days after surgery,14 days after surgery,and 30 days after surgery.We could find that ALT,AST,ALP,lac of the two groups on the first day after surgery,ALT,ALP of the third day after surgery,ALT,lac of the seventh day after surgery,and ALT,TB,DB of the fourteenth day after surgery showed statistically significant differences(P < 0.05),while the other results showed no statistically significant differences(P > 0.05).Conclusion: From the recovery of various indexes of the two groups of recipients after surgery,we can find that the recovery of liver function in the reconstruction group is better than that in the control group.No serious postoperative complications such as bleeding and biliary fistula occurred in the two groups.In the 6 recipients in the control group,due to lack of IV hepatic portal vein reconstruction and IV hepatic insufficiency,ultrasound indicated early atrophy and necrosis of IV liver,slow decline of ALT and poor recovery of liver function in the early postoperative period,leading to high TB and DB levels.Postoperative ultrasonography of the 13 recipients in the reconstruction group indicated that blood flow passed through the portal vein reconstruction vessels within 2 weeks after surgery,and the rate of liver atrophy at segment IV was significantly slower than that in the control group,and liver function recovered faster after surgery.Thus,intraoperative on portal vein in liver IV reconstruction can effectively reduce the liver cell damage,retain more liver function,promote patients early postoperative liver function recovery,and then improve the prognosis of patients,intraoperative liver IV section of the portal vein reconstruction plays an positive role in recovery of liver function in 2 weeks.There was no statistically significant effect of segmental IV portal vein reconstruction on liver function recovery 2 weeks after liver transplantation.