共查询到19条相似文献,搜索用时 78 毫秒
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朱志军 《中华肝胆外科杂志》2012,18(10):729-732
劈离式肝移植术是一种理想的扩大供肝利用和缓解供肝短缺矛盾的方法,可以缩短受者等待时间,降低等待期间患者病死率.劈离式肝移植与全肝移植比较,在供肝及受者选择、移植物血管分配、供肝劈分技术要点及移植物保护等方面的要求更严格,是影响劈离式肝移植效果的关键因素.随着对部分肝移植认识的加深,器官保存技术、外科技术的不断发展,并发症预防手段的进步,劈离式肝移植必将拥有更广泛的发展空间. 相似文献
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在过去十数年间,肝移植数量呈几何级增长,美国和欧洲面临着供受体需求数量的巨大差别,越来越多的待移植受体却在等待过程中发生死亡,文献统计认为受体等待死亡率即便是10%~15%也还是被低估的。而随着国内肝移植开展的不断深入和发展,许多移植中心也面临着同样痛楚的现实。 相似文献
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1992年,美国加州大学洛杉矶分校肝移植中心首先尝试了原位劈离式肝移植(SLT),这种最初为获得活体供者移植器官设计的方法被应用于有心跳的脑死亡供者。随着近10年的发展,SLT除了为儿童供肝外,现已成功地应用于成人受者,均取得了较好的效果。术后受者与移植器官存活率甚至超过了全肝移植术。SLT为缓解供肝短缺的矛盾提供了一种有效的方法。 相似文献
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劈离式肝移植的现状 总被引:2,自引:0,他引:2
李强 《中华器官移植杂志》1999,20(3):189-190
988年Pichlmayr等[1]首先报道将1个供肝分离为二,供2个受者移植,同年,Strong等[2]也成功地完成了同一术式的肝移植,并对操作技术进行了描述。早期劈离式肝移植只用于急症移植病例。自1990年开始,劈离式肝移植也由急症手术逐渐应用于择... 相似文献
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劈离式肝移植最新进展 总被引:1,自引:0,他引:1
1998年Pichlmayr[1] 实施首例劈离式肝移植术 (splitlivertransplantation ,SLT)将左右供肝分别移植在一位 6 3岁胆汁性肝硬化患者和一位先天性胆道闭锁症儿童身上。一肝两用 ,缓解了供肝短缺的问题。随着移植术日益完善 ,移植成功率增加 ,现已成为各大移植中心常规手术。1 SLT适应证与手术时机肝移植主要适应证从肝脏恶性肿瘤逐渐转为各种终末期肝病 ,在成人主要是坏死后肝硬化 ,胆汁性、酒精性肝硬化 ,硬化性胆管炎及肝脏恶性肿瘤 ;在儿童主要为先天性胆道闭锁症 ,先天性肝脏代谢障碍性疾病。2… 相似文献
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Vittorio Corno Michele Colledan Maria Clara Dezza Michela Guizzetti Alessandro Lucianetti Gregorio Maldini Domenico Pinelli Mara Giovanelli Marco Zambelli Giuliano Torre Mario Strazzabosco 《Transplant international》2006,19(6):492-499
Skepticism remains about the use of the extended right (ER) split graft (segments I, IV-VIII) for adult liver transplantation. We analyzed the results of primary liver transplantation performed with an ER graft in adult and in pediatric recipients. At our Institution, between October 1997 and June 2005, 32 primary liver transplantations with an ER graft were performed in 22 adult and 10 pediatric recipients. All the splitting procedures were performed in situ. Actuarial patient and graft survival among the adult recipients of the ER graft were 100% and 100% at 1 year, and 94% and 94% at 5 years. In the pediatric recipients, patient and graft survival were 90% and 79% both at 1 and 5 years. No hepatic artery thrombosis (HAT) occurred in the adult group, while in the pediatric recipients HAT occurred in two cases. A higher biliary morbidity occurred in the ER graft group when compared with the whole size graft 34% versus 13% (P = 0.03). However, this did not affect patient and graft survival. The results of this study may represent a further argument in favor of extensive splitting of all suitable grafts. 相似文献
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S. Hayashi Takaharu Nagasaka Taiki Kojima Yasushi Namii Akio Katayama Takaaki Kobayashi Itsuo Yokoyama Hiroshi Takagi 《Transplant international》1998,11(6):408-412
In situ splitting of cadaver livers has been reported to reduce cold ischemic damage, to avoid biliary complications, and
to result in improved graft survival. In this study, which involved a wider application of split liver transplantation (SLT),
we examined the effects of a technique combining both ex situ and in situ splittings in triple SLT in pigs and compared it
to ex situ splitting alone. In the combination splitting group, the splitting between the right and left lobes was done in
situ with perfusion of the left lobe with cold, lactated Ringer's solution; that between the lateral and medical right lobes
was done ex situ in backtable surgery. The time required for in situ splitting was 28 ± 5 min. The time for backtable surgery
and the total ischemia time were significantly shorter in the combination splitting group than that in the ex situ splitting
group (P < 0.05). One day after triple SLT, the elevations in both serum AST and LDH in the ex situ splitting group were significantly
greater than those in the combination splitting group (P < 0.05). We conclude that combination splitting may provide a technical improvement and have a beneficial effect on the clinical
application of triple SLT.
Received: 21 October 1997 Received after revision: June 9, 1998 Accepted: July 8, 1998 相似文献
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Dimitri Sneiders Anne-Baue R. M. van Dijk Wojciech G. Polak Darius F. Mirza M. Thamara P. R. Perera Hermien Hartog 《Transplant international》2021,34(12):2534-2546
Full-left-full-right split liver transplantation (FSLT) for adult recipients, may increase the availability of liver grafts, reduce waitlist time, and benefit recipients with below-average body weight. However, FSLT may lead to impaired graft and patient survival. This study aims to assess outcomes after FSLT. Five databases were searched to identify studies concerning FSLT. Incidences of complications, graft- and patient survival were assessed. Discrete data were pooled with random-effect models. Graft and patient survival after FSLT were compared with whole liver transplantation (WLT) according to the inverse variance method. Vascular complications were reported in 25/273 patients after FSLT (Pooled proportion: 6.9%, 95%CI: 3.1–10.7%, I2: 36%). Biliary complications were reported in 84/308 patients after FSLT (Pooled proportion: 25.6%, 95%CI: 19–32%, I2: 44%). Pooled proportions of graft and patient survival after 3 years follow-up were 72.8% (95%CI: 67.2–78.5, n = 231) and 77.3% (95%CI: 66.7–85.8, n = 331), respectively. Compared with WLT, FSLT was associated with increased graft loss (pooled HR: 2.12, 95%CI: 1.24–3.61, P = 0.006, n = 189) and patient mortality (pooled HR: 1.81, 95%CI: 1.17–2.81, P = 0.008, n = 289). FSLT was associated with high incidences of vascular and biliary complications. Nevertheless, long-term patient and graft survival appear acceptable and justify transplant benefit in selected patients. 相似文献
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Koki Tanaka Naoki Ishizaki Akihiro Nishimura Meguru Yoshimine Ryozo Kamimura Akira Taira 《Surgery today》1993,23(7):609-614
An animal model of split liver transplantation using pigs is described herein. The donor liver was divided into two grafts, the right graft consisting of the right medial and lateral segments with the caudate lobe, and the left graft consisting of the left lateral and medial segments. To make implantation easier, a distal part of the donor's inferior vena cava (IVC) was isolated and attached to the left graft with an anastomosis between the orifice of the renal vein and the graft's hepatic vein. The left graft thereby contained a newly constructed retrohepatic IVC for anastomosis to the recipient. During the anhepatic phase, no conventional bypass procedure was used, but an abdominal aortic clamp in combination with general hypothermia was employed. Ten pigs were used as donors and a total 20 liver transplantations performed. No immunosuppressive drugs were given in this series. Ten of the 20 recipients survived for more than 2 days, the mean survival time being 4.7 days, with a range of 2–14 days. The mean survival time of the left grafts was much longer than that of the right grafts, although no technical problems such as kinking of the graft or occlusion of the hepatic vein were encountered in either. This model is the first report of split liver transplantation in animals. The advantages of using the infrahepatic IVC graft include stability of the graft and safe hepatectomy. This model will therefore be useful for the experimental study of split liver transplantation and may also be employed for clinical use in the future. 相似文献
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Improving graft survival by understanding the mechanism of segment 4 complications after split liver transplantation 下载免费PDF全文
Shohei Komatsu Fernando Pompeu Piza Vicentine Sanaâ El Mouhadi Raffaele Brustia Fabiano Perdigao Ailton Sepulveda Olivier Soubrane Olivier Scatton 《Clinical transplantation》2016,30(9):1165-1172
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Chandra S. Bhati Stephen J. Wigmore Sriniwas Reddy David A. Mayer John A.C. Buckels Manas Derek Darius F. Mirza 《Clinical transplantation》2010,24(1):98-103
Bhati CS, Wigmore SJ, Reddy S, Mayer DA, Buckels JAC, Derek M, Mirza DF. Web-based image transmission: a novel approach to aid communication in split liver transplantation.
Clin Transplant 2010: 24: 98–103. © 2009 John Wiley & Sons A/S. Abstract:
Background: Split liver transplantation (SLT) is technically demanding and requires good communication between transplant centers. The recipient surgeon receiving a shipped split liver needs detailed information on allocation of inflow and outflow vessels. We describe the first use of an image transmission system to facilitate SLT.
Methods: Twenty cadaver livers undergoing ex situ splitting were studied. Fifteen were shared between the geographically separate Birmingham adult and pediatric centers and five were shared with other UK centers.
Results: A total of six to eight images of each split graft were taken with a camera at standardized settings using the National Organ Retrieval Imaging System (NORIS), showing details of appearance, size, and anatomy of allocated inflow and outflow vessels. These were uploaded using a personal digital assistant to a secure website ( http://www.noris.org.uk ). The remote recipient surgeon then viewed these images by logging onto the password-protected website. Minimum time interval between division of the hilar vessels and completion of the split procedure was two h, allowing remote surgeon to view their allocated "shipped" graft in advance of commencing surgery.
Conclusion: This advanced yet simple image transmission system has the potential for routine application in transplant surgery, not only for splitting but also for reporting injuries and graft steatosis. 相似文献
Clin Transplant 2010: 24: 98–103. © 2009 John Wiley & Sons A/S. Abstract:
Background: Split liver transplantation (SLT) is technically demanding and requires good communication between transplant centers. The recipient surgeon receiving a shipped split liver needs detailed information on allocation of inflow and outflow vessels. We describe the first use of an image transmission system to facilitate SLT.
Methods: Twenty cadaver livers undergoing ex situ splitting were studied. Fifteen were shared between the geographically separate Birmingham adult and pediatric centers and five were shared with other UK centers.
Results: A total of six to eight images of each split graft were taken with a camera at standardized settings using the National Organ Retrieval Imaging System (NORIS), showing details of appearance, size, and anatomy of allocated inflow and outflow vessels. These were uploaded using a personal digital assistant to a secure website ( http://www.noris.org.uk ). The remote recipient surgeon then viewed these images by logging onto the password-protected website. Minimum time interval between division of the hilar vessels and completion of the split procedure was two h, allowing remote surgeon to view their allocated "shipped" graft in advance of commencing surgery.
Conclusion: This advanced yet simple image transmission system has the potential for routine application in transplant surgery, not only for splitting but also for reporting injuries and graft steatosis. 相似文献
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E. S. Xenos F. Khan J. Nery R. Romero J. Mocros A. Tzakis 《Transplant international》1999,12(1):63-67
Scarcity of size-matched grafts continues to be a major limiting factor for liver and combined liver/intestinal transplants
in the pediatric population. It is reported that 29 % of pediatric patients listed for hepatic transplantation die while waiting
for a donor. The reported mortality of pediatric patients awaiting intestinal transplantation is about 40 %. We report on
a technique of segmental liver and intestinal transplantation in a child. To our knowledge, this is the first report of a
combined split liver-intestinal transplantation. We used a cadaveric donor, but the technique can also be performed with a
live donor. The adult recipient of one segment of the liver was discharged home without complications. The child who received
the combined liver intestinal graft developed intestinal perforation and severe rejection and died. If this technique is applied
successfully, the adverse effects and mortality of a long pretransplant waiting period in pediatric patients may be avoided.
Received: 7 May 1998 Received after revision: 29 September 1998 Accepted: 12 October 1998 相似文献
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目的探讨超声造影鉴别膀胱良恶性占位的诊断价值。
方法对2018年5月至2019年12月在深圳市龙岗区第三人民医院因膀胱占位行超声造影检查的15例患者共17个病灶进行分析,观察病变位置、大小、数目,肿块内是否有血流信号,超声造影是否有增强及造影剂到达时间,增强模式。
结果17个病灶中恶性病灶13个(膀胱乳头状尿路上皮癌12个、膀胱肉瘤样癌1个),良性病灶4个(腺性膀胱炎1个,膀胱沉积物或凝血块3个),病灶大小(2.8±1.5)cm。超声造影诊断恶性病灶准确率高于常规超声(χ2=0.215,P=0.046)。膀胱乳头状尿路上皮癌超声造影到达时间为(20.7±6.0)秒,增强模式为均匀高增强、缓慢慢退;膀胱肉瘤样癌超声造影到达时间为13秒,增强模式为均匀高增强、快速消退;腺性膀胱炎超声造影到达时间为24秒;3个膀胱凝血块表现为无增强。
结论超声造影能明显提高常规超声对膀胱占位的检出和鉴别诊断能力。 相似文献