血缘性活体肝部分移植术一例报告

目的介绍１例血缘性活体肝部分移植术的临床体会。方法受体为１０岁女童,诊断为先天性弥漫性肝内胆管囊性扩张症、复发性胆管炎、肝硬变,供体为患儿的父亲,手术方式为切取供体肝脏的左外侧叶,并原位移植给患儿。术后进行了严格的监护治疗和随访。结果供体手术历时４００分钟,出血４１０ｍｌ,切取肝脏３００ｇ,术后顺利恢复。受体手术历时６５２分钟,出血１６６５ｍｌ,无肝期８０分钟,移植肝脏热缺血时间为０,冷缺血时间１３７分钟。采用环孢霉素Ａ、硫唑嘌呤及皮质激素行免疫抑制治疗,术后第１１天出现急性排斥反应,经激素冲击治疗而愈。现患者已健康生存７个月余,肝功能正常。结论在现有外科技术条件下,活体肝部分移植术是可行的。良好的术后管理是确保肝移植术成功的关键。

Living related liver transplantation: a case report

OBJECTIVE: To study a case of living related liver transplantation. METHOD: The patient was a 10-year-old girl who suffered from congenital diffuse intrahepatic cholangiectasis, recurrent cholangitis and hepatocirrhosis. The donor was the patient's father aged 40. The left lateral lobe of donor's liver was cut and grafted to the patient. Intensive care and treatment as well as follow-up were given after operation. RESULT: For the donor, the operation lasted 400 min, with 410 ml bleeding and 300 g liver removed. The recovery was satisfactory. For the recipient, the operation lasted 652 min, with 1665 ml bleeding, 80 min non-liver stage, 0 min graft hot ischemic stage, and 137 min cold ischemic stage. Immunosuppressive therapy was given using cyclosporin A, azathioprine and adrenocortical hormones. There was an acute rejection 11 days after operation, which was controlled using hormone impulsive therapy. The patient has been surviving 7 months with normal liver function. CONCLUSION: The living related liver transplantation is feasible under modern surgical conditions. It is demonstrated that perfect postoperative management is the key for the successful liver transplantation.