辅助性原位活体肝部分移植一例报告

目的：探讨应用辅助性原位活体肝部分移植治疗Willson's病的可行性。方法：受体女性，20岁，O型血，因肝豆状核变性而接受辅助性原位活体肝部分移植。供体男性，21岁，A型血。手术切除受体病肝左外叶260g，取供体左外叶肝脏295g原位移植于受体。因供受体血型不同，术前行血浆置换，术后以FK506，激素，环磷酰胺联合免疫抑制治疗。结果；受体术后15d出现肝动脉血塞形成，予以溶栓治疗后出现腹腔内出血，术后17d开腹止血，清除血肿，术后发生腹水，肺不张，胆瘘等，均治愈。至今患者已生存1年3个月，并恢复正常生活，铜蓝蛋白水平正常。移植肝脏体系明显增大，手足震颤明显减轻。结论：辅助性原位活体肝部分移植是治疗Willson's病可行的方法。     

亲体部分肝移植治疗Wilson病20例报告

目的探讨亲体部分肝移植治疗肝豆状核变性病 (Wilson病 )的价值。方法 2 0 0 1年 1月至 2 0 0 3年 10月 ,我院连续为 2 0例Wilson病患者成功施行亲体部分肝移植术 ,男性 8例 ,女性 12例 ,年龄 7～ 2 0岁 ,平均 11 1岁。 3例是暴发性肝功能衰竭 ,17例慢性进行性肝损害。供肝者为患者父亲或母亲。结果供受体手术顺利 ,术后 1个月肝功能和铜蓝蛋白恢复正常水平。 19例病人健康存活 ,1例术后 72d死于排斥反应。术后并发症包括 :醒状昏迷 1例 ,肝动脉血栓形成 1例 ,创面胆漏 1例 ,平均随访 18 9个月。结论亲体部分肝移植是治疗Wilson病并发肝功能衰竭的有效疗法。     

原位肝移植治疗肝豆状核变性长期存活一例报告

报告１例人体同种异原位肝移植手术病例，受者为肝豆状核变性（腹型失代偿期）供者为男性脑死亡者，采用ＵＷ液灌注和保存，快速取肝，冷缺血时间为８小时，采用供体髂动脉架桥，重建变异肝动脉血供，术后应用环孢霉素合并泼尼松二联免疫抑制治疗，克服了腹腔迟发性大出血，急性排异反应，二重感染，霉菌感染及环孢霉素对肝脏的毒性作用等并发症，对术后出现的胆道并发症采用了经Ｔ管行胆道冲洗和Ｆｏｇａｒｔｙ导管疏通于手术一年后     

原位肝移植治疗肝豆状核变性一例报告

报告１例人体同种异体原位肝移植手术及术后经过，受者的原发病为肝豆状核变性（肝型失代偿期）。采用ＵＷ液灌洗和保存，快速取肝。冷血时间为８小时，受者的肝动脉变异，通过供体髂动脉架桥使供肝动脉与肾平面下方腹主动脉吻合。术中未采用静脉转流，血液动力学未见明显变化，术后肾功能无明显异常。术后应用环孢素Ａ＋泼尼松二联免疫抑制治疗，克服了腹腔迟发性大出血、急性排斥反应、二重感染、霉菌感染及环孢素Ａ对肝脏的毒性作     

亲体部分肝移植治疗肝豆状核变性

目的　研究亲体部分肝移植术在肝豆状核变性 (Wilson’s病 )治疗中的应用价值。方法　 2 0 0 1年 1月至 2 0 0 1年 1 2月连续为 1 0例Wilson’s病患者施行肝移植术 ,供肝者均为患者的母亲。结果　手术全部获得成功 ,术后无严重并发症发生 ,均恢复顺利。术后铜氧化酶均显著升高 ,分别从术前 (9.9± 9.3)U/L升高至术后 (1 2 4 .0± 33 .8)U/L ;角膜缘K F环均明显变淡 ;神经系统症状改善 ;现已分别存活 1 2、1 1、1 0、8、7、7、3、3、2和 1个月。结论　肝移植术是治疗肝豆状核变性的有效手段。亲体部分肝移植术具有供肝来源可靠、临床疗效好、费用低的优点 ,应用前景广阔。     

不行体外静脉转流原位肝移植治疗肝豆状核变性一例

我院于 2 0 0 1年 9月为一名肝豆状核变性患者成功施行了不经体外静脉转流的经典式同种异体原位肝移植 ,目前患者存活 1 2个月。现报告如下。一、资料与方法1 .受者情况 :男性 ,2 0岁 ,体重 53ｋｇ ,临床诊断为肝豆状核变性 ,于 2 0 0 1年 9月 2 9日在全身麻醉下行原位肝移植术。术中见病肝呈重度结节样硬变 ,无腹水 ,血管无变异。2 .供肝切取 :供肝取自于一体重 50ｋｇ、2 2岁之男性尸体 ,与受者同为Ｂ型血。供肝切取采用快速多器官联合切取技术 ,肠系膜上静脉和腹主动脉插管 ,以ＵＷ液灌洗 ,灌洗液总量约为 2 0 0 0ｍｌ,离体后经门静脉灌…     

辅助性部分原位肝移植治疗Wilson病一例

辅助性部分原位肝移植 (auxiliarypartialorthotopiclivertransplantation ,APOLT)是 2 0世纪 90年代发展起来的一项辅助性肝移植技术 ,该术式兼有原位肝移植和异位肝移植的优点 ,应用于急性或亚急性肝功能衰竭及某些肝脏先天代谢性疾病患者取得了良好的的疗效。我院器官移植中     

背驮式原位肝移植术四例报告

目的 为了提高终末期肝病的存活率。方法 于１９９６年５月、８月、１９９７的上月和１９９８年２月先后成功地施行了４例背驮式原位肝移植术。结果 除例１忆 炎后肝硬变,受体术后２１４天突变死于乙肝复发并急生肝坏死和急性胰腺炎外。例２、例３和例４肝豆状核变性受体术后恢复顺利,效果良好,已分别健康生存５７５天、３９０天和１６２天。结论 肝移植是目前治疗大部分终末期肝移植的最有效手段。     

Cadaveric domino liver transplantation: the first case in Japan

The first case of domino liver transplantation from a brain-dead donor in Japan is described. A 49-year-old man with familial amyloidotic polyneuropathy received a cadaver liver, and his native liver was transplanted into a 53-year-old man with polycystic liver and kidney disease. The cadaveric liver allograft was transplanted by the conventional technique. The graft taken from the first recipient had four outflow orifices (the left, middle, and right hepatic veins, and upper vena cava), for which a single orfice was created at the back table. This graft was transplanted in piggy-back fashion. The first recipient developed acute rejection on day 13 and hepatic artery stenosis on day 36. These were treated by steroid recycle therapy and percutaneous transarterial angioplasty. He was discharged on day 57 with normal liver function. The second recipient underwent re-operation for bleeding from the right adrenal gland and left thoracic cavity. He was diagnosed with acute rejection on day 7, which was treated by steroid pulse therapy. He was discharged uneventfully on day 39 with normal liver function.     

Native hepatectomy after auxiliary partial orthotopic liver transplantation

In countries where a living donor is the only source of the graft, the limited size of the graft is of serious concern when considering extending the procedure to adult recipients. In order to overcome this problem, auxiliary partial orthotopic liver transplantation (APOLT) was applied to the concept that the residual native liver would support the graft function until the graft expanded enough to work by itself. We herein report on a 20-year-old woman with primary sclerosing cholangitis (PSC), who received a small-size liver graft by APOLT. Computed tomography and scintigraphy showed that the graft had regenerated sufficiently 1 month after the operation. The diseased residual native liver is potentially carcinogenetic. Therefore, second-stage native hepatectomy was done 35 days after the first operation. Histopathologic examination of the resected native liver revealed biliary cirrhosis with PSC but no evidence of cholangiocarcinoma. Second-stage native hepatectomy after APOLT seems to be a curative treatment for chronic end-stage liver disease with graft size mismatch that may be as good as orthotopic liver transplantation. Received: 22 October 1998 Received after revision: 15 January 1999 Accepted: 26 February 1999     

Bridging hyperacute liver failure by ABO-incompatible auxiliary partial orthotopic liver transplantation

Uncontrollable intracranial pressure elevation in hyperacute liver failure often proves fatal if no suitable liver for transplantation is found in due time. Both ABO-compatible and auxiliary partial orthotopic liver transplantation have been described to control such scenario. However, each method is associated with downsides in terms of immunobiology, organ availability and effects on the overall waiting list.     

Functional portal flow competition after auxiliary partial orthotopic living donor liver transplantation in noncirrhotic metabolic liver disease

Auxilliary partial orthotopic liver transplantation (APOLT) was introduced initially as a tentative or permanent support for patients with potentially reversible fulminant hepatic failure and has extended its indication to congenital metabolic disorder of the liver that has otherwise normal functional integrity. Postoperative management of APOLT is complicated because of functional portal flow competition between the native and graft liver. The native portal vein diversion to the graft is sometimes indicated to prevent functional competition; however, it is still an open question whether this technique can be theoretically indicated for APOLT patients. The authors report a on patient with ornithine transcarbamylase deficiency who received APOLT from a living donor without native portal vein diversion. Because of functional portal vein competition between the native and graft liver, the patient had to have portal vein diversion, portal vein embolization, and finally native hepatectomy to induce the graft regeneration after APOLT. After the experience of the current case, primary portal vein diversion for APOLT with noncirrhotic metabolic liver disease patients to prevent functional portal flow competition is recommended.     

Cadaveric small bowel/split liver transplantation in a child

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     

大鼠原位辅助性肝移植治疗急性肝功能衰竭

为了评价大鼠原位辅助性部分肝移植（ＡＰＯＬＴ）对急性肝功能衰竭的支持作用。切除７５％的肝脏并阻残余肝脏的血供５０分钟导大鼠急性肝功能衰竭。治疗组受体计切除７５％并将３０％的供肝植于原位，然后阻断残余的右上叶的右下叶之血供５０分钟。结果显示，大鼠急性肝功能衰竭的５天生存率仅３３％，而接受ＡＰＯＬＴ者５天生存率和移植肝存活率分别为８０％和７３％，术后第５天肝功能基本恢复正常。可见，大肝切除和余肝缺血诱     

小体积肝移植和辅助性原位小体积肝移植治疗猪急性肝功能衰竭的近期疗效观察

目的观察小体积肝移植和辅助性原位小体积肝移植治疗猪急性肝功能衰竭的近期疗效。方法急性肝功能衰竭猪随机分为3组接受肝移植治疗:A组行全肝移植(n=5);B组行小体积肝移植(n=5);C组行辅助性原位小体积肝移植(n=5)。各组动物开腹后即刻、切脾后即刻和再灌注后30 min分别监测门静脉压力,并观察术后生化指标变化、病理改变和1周生存率。结果A、B和C三组的移植肝重量与受体体重之比分别为(2．44±0．30)％、(0．76±0．02)％和(0．75±0．03)％。再灌注后30 min,B组移植肝门静脉压力显著高于其它两组(A:B:C=13．3:17．5:12．2 cmH2O, P<0．01),C组原肝门静脉压力显著高于移植肝门静脉压力(14．3:12．2 cmH2O,P<0．05)。A组和C组术后第2天起血清天冬氨酸转氨酶、总胆红素、凝血酶原时间、乳酸和血氨水平明显下降,术后第7天基本恢复至正常水平。B组术后上述生化指标一直维持在较高的水平,术后第2～4天明显高于其它两组(P<0．01)。A组、B组和C组1周生存率分别为100％、20％和80％,B组明显低于其它两组(P<0．05)。结论辅助性原位小体积肝移植治疗急性肝功能衰竭近期疗效优于小体积肝移植,术中不必干预原肝门静脉。     

猪辅助性部分肝移植模型制作及比较

目的建立猪的辅助性部分肝移植模型,观察其肝功能和术中血流动力学变化。方法 24头健康良种家猪,体质量23-30 kg,被随机分为供体(n=12)和受体(n=12)。气管插管 全麻,硫喷妥钠静脉维持。移植前切除受体肝左叶,供肝右叶作为植入肝。预实验2例行经体位转流的原位辅助性部分肝移植,对照组(5例)行简易转流下的原位辅助性部分肝移植。模型组(5例)行异位辅助性部分肝移植, 供肝被植入受体肝下间隙,供肝肝上下腔静脉与受体肝下下腔静脉端侧吻合,供肝门静脉与受体门静脉行端侧吻合,供肝肝动脉与受体脾动脉行端端吻合。供肝胆总管置管外引流。结果预实验中行体位静脉转流的原位辅助性部分肝移植的2例受体在肝上下腔静脉阻断后很快陷入血流动力学紊乱死亡。5例行简易静脉转流的原位辅助性部分肝移植的受体,2例在24 h内死亡,1例28 h,2侧超过48 h。而模型组受体 5例中有4例存活超过24 h。AST,ALT指标手术开始至术后24 h呈持续升高。模型组术中血流动力学较其他组稳定。结论该辅助性肝移植模型简明易建且具有不需静脉转流等优点,为研究辅助性部分肝移植原肝和供肝功能及血流变化提供了理想的平台。