活体右半肝移植供体术前评估的临床意义

目的 探讨活体右半肝移植供体术前评估的必要性.方法 回顾性评估2002年1月至2005年11月施行的23例活体右半肝移植中供体的情况.术前评估包括供体的一般情况,血管与胆管系统影像学,供肝体积及脂肪变性情况等.不阻断入肝血流,在肝中静脉右侧,用超声刀离断肝组织而得到右半肝.计算供体标准肝体积（standard liver volume,SLV）及残余左半肝的比例.结果 术前影像学评估发现,4例门静脉主干有3分支,7例有粗大肝右后下静脉（≥0.5 cm）,5例有粗大（≥0.5 cm）肝V段静脉（V5）,4例有V8,右肝管变异3例.而术中发现9例伴右后下静脉,5例V5,5例V8,右肝管变异4例.术中肝切取活检示2例供肝轻度脂肪变性.右半供肝切取平均失血462 ml,切取右半肝占SLV的39.7％～69.5％,残余左半肝占30.5％～60.3％.术后第1天肝功能均有不同程度损害,但术后1周恢复到接近正常水平.术后并发症包括1例腹内出血,1例乳糜漏,2例切口脂肪液化,1例门静脉狭窄伴血栓形成.所有供体均恢复良好.结论 术前进行供肝血管系统与胆管系统、肝脏的体积与质量的详尽评估,选择出最适宜的供肝与供体,是手术成功的重要保证.

Clinical importance of preoperative evaluation on donors in living donor's right liver transplantation

Objective To investigate the necessity of detailed preoperative evaluation on donors in living donor's right liver transplantation. Methods Data of 23 living donors of right hepatic lobe graft from January 2002 to November 2005 were retrospectively studied. Preoperative evaluation included donor's general condition, imaging study of hepatic vasculature and bile duct system, hepatic volumetry and hepatic steatosis. The right lobe grafts were obtained by transecting the liver without the inclusion of the middle hepatic vein. The standard liver volume (SLV) and the ratio of left lobe volume to SLV were calculated. Results Portal vein had three major branches in 4 cases, accessory right hepatic vein larger than 5 mm in diameter was found in 7 cases, 5 cases had large vein draining into middle hepatic vein (V_5), 4 cases had V_8 and 3 case had variation of right bile duct. Intraoperatively, 9 cases were found to have accessory right hepatic vein, 5 had V_5, 5 had V_8 and 4 with variations of the right bile ducts. There were 2 cases with slight steatosis. The mean operative blood loss was 462 ml during the process of grafting. The volume of right hepatic lobe graft ranged from 39. 7% to 69.5% of SLV with the ratio of residual left liver from 30. 5% to 60. 3%. On postoperative day 1 the impairment on donors liver functions was universal which subsided at the end of the first week. Complications included intraabdominal bleeding in 1 case, chyloperitoneum in one, and wound seatoses in 2. All donors recovered smoothly. Conclusion Detailed preoperative evaluation of hepatic vasculature and bile duct system, hepatic volumetry and hepatic quality is of clinical importance in the selection of suitable donor in liver right liver transplantation.