成人活体肝移植治疗终末期肝病

目的探讨成人活体肝移植治疗终末期肝病的方法及技术要点。方法回顾性分析2000年9月至2005年6月的成人活体肝移植患者12例。其中,左半肝(Ⅱ、Ⅲ、Ⅳ段,包括肝中静脉)移植3例;右半肝(Ⅴ、Ⅵ、Ⅶ、Ⅷ段)不包括肝中静脉移植8例,包括肝中静脉1例。结果 12例供体无因手术死亡者。手术时间(6．20±1．40)h;术中出血量300-1 200 ml;1例术后并发胆瘘,1例切口脂肪液化;随访 6-12个月,无远期并发症发生,术后3-6个月恢复工作。受体手术时间5-11 h;采用改良方法重建移植肝流出道、显微外科技术重建肝动脉、端端吻合重建胆道;术中出血800-7000 ml;移植物冷缺血时间(1．90±0．50)h;无肝期时间(1．63±0．43)h;移植肝重量与受体体重比为1．20％±0．26％。1例受体术后并发腹腔内局限性胆瘘,1例病死,11例长期生存。结论成人活体肝移植是解决供肝短缺、治疗终末期肝病的有效方法,同时能相对保证供体的安全。

Adult-to-adult living donor liver transplantation for decompensated end-stage liver diseases

OBJECTIVE: To summarize our clinical experience in adult-to-adult living donor liver transplantation (ALDLT). METHODS: Clinical data of 12 patients with ALDLT performed in our center from September 2000 to June 2005 were analyzed, retrospectively. RESULTS: Left lobe (segments II, III, IV, including the middle hepatic veins) transplantation was performed in 3 patients and right lobe (segments V, VI, VII, VIII, with or without the middle hepatic veins) transplantation was performed in 9 patients. Donors: There were no operative deaths. The median operative time was 6.20+/-1.40 hours and their blood loss ranged from 300 ml to 1200 ml. Postoperative complications included biliary fistula (1 donor) and wound fat liquefaction (1 donor). During a 6-12 months follow-up, no long-term complications were found. Recipients: The operating time ranged from 5 to 11 hours and their blood loss ranged from 800 to 7000 ml. Modified outflow reconstruction, microvascular reconstruction of the hepatic artery and duct-to-duct biliary reconstruction were done during the recipient operations. The median cold ischemia time was 1.90+/-0.50 hours. The median anhepatic phase of recipients was 1.63+/-0.43 hours. Graft/recipient weight ratio (GRWR) was (1.20+/-0.26)%. One recipient presented a postoperative complication of biliary fistula and another recipient died 1 month after the operation from serious infection. The other 11 recipients had long-term survivals. CONCLUSION: ALDLT is an effective treatment for decompensated end-stage liver disease patients and is relatively safe for the donors.