成人间活体肝移植研究

目的探讨提高成人间活体肝移植存活率的手术方法。方法2005年3月至6月,我院施行了13例成人间右半肝活体肝移植,术中采用了改良的手术技术包括右肝静脉的重建,肝中静脉分支的搭桥,肝动脉搭桥及改进的胆道重建技术。结果全组供体无严重并发症及死亡;受体发生并发症4例．其中包括肝动脉栓塞、胆漏、右膈下脓肿及肺部感染各1例。1例再移植因术后肺部感染,并发多器官功能衰竭（MOF）死亡。13例行右肝静脉与下腔静脉（IVC）直接吻合,其中5例加行右肝下静脉重建．另5例采用自体大隐静脉搭桥行肝中静脉分支与IVC重建,保证了右肝的流出道通畅。移植物与受体重量比（GRWR）为0．72％～1．24％,其中9例〈1．0％,2例〈0．8％,无小肝综合症发生。结论采用改进的手术技术,特别是肝静脉流出道的充分重建可有效的避免小肝综合症,从而使活体右半肝移植成为比较安全的手术。

Adult-to-Adult Living Donor Liver Transplantation

OBJECTIVE: To investigate the approach which could improve the survival rate of adult-to adult living donor liver transplantations, that right lobe liver grafts were performed by a modified technique. METHODS: During from March to June 2005, 13 patients underwent the living donor liver transplantation with right lobe grafts via the improved surgical techniques including the reconstruction of right hepatic vein; the tributaries of the middle hepatic vein were reconstructed by interpositioning a vein grafts; the anastomosis of the hepatic arteries and bile ducts. All cases underwent the direct anastomosis of right hepatic vein and IVC, of whom 5 cases were added with the reconstructions of right inferior hepatic vein, and other 5 cases added with reconstructing the tributaries of the middle hepatic vein by interpositing a vein graft to provide sufficient venous outflow. RESULTS: No donor suffered from severe complication or death. Four complications occurred in recipients who got the hepatic artery thrombosis (1 case), bile leakage (1 case), right subphrenic abscess (1 case) or pulmonary infection (1 case) respectively. The recipient with pulmonary infection died of MOF. The graft organ and recipient weight ratio (GRWR) were between 0.72% and 1.24%, that the ratios of 9 cases was < 1.0% and 2 cases < 0.8%, with no "small-for-size syndrome" occurred. CONCLUSIONS: The improved surgical techniques, especially the reconstruction of hepatic vein to provide sufficient venous outflow, can make the adult-to-adult living donor liver transplantation with right lobe liver grafts become a relatively safe operation and prevent the "small-for-size syndrome".