改进成人间活体供肝移植的手术技术

目的研究并改进成人间活体供肝移植的手术技术。方法自2002年1月至2005年8月,施行了16例成人间活体右半供肝移植。手术中改进了技术,包括右肝静脉重建、肝中静脉分支搭桥、肝动脉搭桥及胆道吻合等。结果所有供者均无严重并发症及死亡。移植肝与受者重量比（GRWR）为0．72％～1．24％,其中9例〈1．0％,2例〈0．8％。手术除了采用移植肝的右肝静脉与受者下腔静脉（IVC）直接吻合外,5例加行右肝下静脉重建、5例取自体大隐静脉行肝中静脉分支与IVC间搭桥,保证了右肝流出道通畅。最早手术的2例受者中,1例发生肝静脉吻合口狭窄,另1例发生小肝综合征,最终导致死亡。后阶段手术的14例受者均未发生小肝综合征;发生并发症5例,分别为急性排斥反应、肝动脉栓塞、胆漏、左膈下脓肿及肺部感染;1例再次肝移植后因肺部感染,多器官功能衰竭（MOF）死亡。结论活体供肝移植中采用改进的手术技术,特别是肝静脉流出道重建的方法,可有效避免发生小肝综合征。

Improvement of surgical technique for adult-to-adult living donor liver transplantation

Objective To investigate the modifications of surgical technique in adult-to-adult living donor liver transplantation (A-A LDLT) using right lobe liver grafts.Methods From Jan.2002 to Aug.2005,16 patients underwent living donor liver transplantation using right lobe grafts.During operation,a modification,designed to improve the reconstruction of right hepatic vein,the reconstruction of the tributaries of the middle hepatic vein by interpositing a vein graft,and the anastomosis of the hepatic arteries and bile ducts,was done.Results In these series,there were no donor severe complication and death.The graft and recipient weight ratio(GRWR) was between(0.72%) and(1.24%),among these,9 cases <(1.0%) and 2 case (<0.8%),and no "small-for-size syndrome" occurred.In all 16 patients,besides direct anastomosis of right hepatic vein and IVC,5 cases were subjected to the reconstructions of right inferior hepatic vein,and other 5 cases to the reconstruction of the tributaries of the middle hepatic vein by interpositing a vein graft to provide sufficient venous outflow.In the first 2 cases receiving surgical operations,one case had stenosis of the right hepatic vein anastomoses,and another one had small-for-size syndrome and died.In the remaining 14 cases,5 complications occurred in recipients including acute rejection(n=1),hepatic artery thrombosis(n=1),bile leakage(n=1),left subphrenic abscess(n=1) and pulmonary infection(n=1).One patient with pulmonary infection was died due to MOF.Conclusion With modifications of surgical technique,especially the reconstruction of hepatic vein to provide sufficient venous outflow,living donor liver transplantation in adults using right lobe liver grafts can become a relatively safe procedure and prevent the "small-far-size syndrome".