婴幼儿亲属活体部分供肝肝移植中的供、受者安全性分析

目的 探讨婴幼儿亲属活体部分供肝肝移植中的供、受者的安全性.方法 2006年9月至2009年11月,行婴幼儿亲属活体部分供肝肝移植者8例,受者原发病均为先天性胆道闭锁.供者术前常规行三维CT观察和计算全肝及肝叶(段)体积及形状,磁共振胰胆管造影术(MRCP)了解胆道情况.根据婴幼儿受者腹腔容积切取合适肝叶(段)行肝移植术.受者术后给予抗排斥反应和预防感染等治疗;供者术后给予保肝和抑酸治疗.分析供、受者术前、术中及术后情况.结果 8对供、受者手术均获成功.6例供肝为左外侧叶,1例为S3肝段,1例为减体积S3肝段,供肝重量为(235.9±53.6)g(148～302 g),供肝重量与受者体重比(GW/RW)为(2.65±0.48)%(2.11%～3.36%).对供、受者随访3～40个月(中位数18个月),8例供者均存活,发生并发症2例(25%).8例受者中,死亡1例(12.5%),其他受者发生并发症13例次.结论 术前对供、受者行精确评估,切取合适供肝行肝移植术,术中精细操作,术后精心治疗可最大程度保证供、受者的安全.

The safety of donors and recipients in infant living donor liver transplantation

Objective To investigate the safety of donors and recipients in living donor liver transplantation (adults to infants). Methods From September 2006 to November 2009, 8 living donor liver transplantations were performed, and all of the recipients were diagnosed as having congenital biliary atresia. Triphasic liver computed tomography was used to display the shape of the liver and calculate total liver and liver lobes volumes in donors. Magnetic resonance cholangiopancreatography (MRCP) was used to examine the conditions of the bile tract. Suitable liver lobe was resected depending on the condition of recipients' abdomen. After the operation, all of the recipients received treatments including anti-rejection, anti-infection, etc. All the donors received liver protection and antisecretory treatments. The preoperative, intraoperative and postoperative states of donors and recipients were analyzed. Results All of the operations were performed successfully. For the grafts, 6 left lateral lobes, 1 hepatic S3 and 1 reduced-size hepatic S3 were obtained. The weight of lobe grafts was 148-302 g (235. 9 ± 53. 6 g). The ratio of graft weight to recipient weight ranged from 2. 11% to 3. 36 % (2. 65 % ± 0. 48 %). During a follow-up period of 3-40 months (median 18 months), there was no donor mortality, but 2 (25%) donors experienced complications. One (12. 5 %) of the 8 recipients died, and the remaining developed 13 cases/times of complications.Conclusion Accurate assessment of recipients and donors preoperatively, suitable resection of the grafts and precise operation intraoperatively, and careful treatment postoperatively can ensure safety of the recipients and donors to the maximum extent.