活体肝移植进展与展望（2000-2020）

活体肝移植比公民逝世后器官捐献肝移植操作更为复杂，围手术期评估及技术实施直接影响供体安全和受体预后。目前，行活体肝移植时，供体选择应遵循“自愿、知情、无害”伦理原则，利用影像学评估供肝质量、解剖结构及残肝体积；受体选择时优先考虑良性终末期肝病病人，而选择肝癌病人应考虑肿瘤分期；移植物选择应满足不同受体的“移植物-受体重量比”标准，对于<3岁的儿童，其比值在2%~4%为宜；在传统开放手术供肝获取经验基础上，腹腔镜供肝获取技术发展与挑战并存；术中各管道重建时，管道条件、匹配程度及通畅性是移植技术的关键；供受体血型不相容时，应用利妥昔单抗可起到减少并发症及改善预后作用；术后精细化管理，尽量减少免疫抑制剂用量以期减少其药物相关副反应。尽管存在诸多问题，相信随着外科技术的进步，医生对肝脏解剖认识的加深及移植物再生血流动力学的理解，活体肝移植技术会更加完备、更加安全。作为公民逝世后器官捐献肝移植的重要补充，活体肝移植将为更多终末期肝病病人提供有效治疗手段。

Advancement and prospect of living donor liver transplantation(2000-2020)

Advancement and prospect of living donor liver transplantation （2000-2020） LYU Guo-yue. Department of Hepatobiliary Pancreatic Surgery, the First Hospital of Jilin University， Liver Transplantation Center of Jilin University, Changchun 130021, China
Abstract Living donor liver transplantation (LDLT) serves as an alternative approach. However, the surgical procedure in LDLT is more complicated when compared with that of deceased donor liver transplantation (DDLT). Perioperative assessment and technique application are significantly associated with donor safety and recipient prognosis. The donor should be selected by following the principles of ‘independence, harmless and informed consent’, and imaging test should be applied to assess the liver quality, anatomical structure, as well as residual liver volume. Patients with benign liver disease of end-stage should be given priority in receptor selection, while for patients with liver cancer, tumor staging should be considered. The graft should meet the graft to recipient weight ratio (GRWR) criteria according to different recipients, especially for children within 3 years old whose appropriate GRWR should be 2% to 4%. In terms of graft procurement, laparoscopic approach is developing fast but also facing challenges, when compared with open surgery. In regarding to reconstruction for the tubes during LT, tube associated conditions, matching degree, and pass-ability are the key procedures during anastomosis. When receiving a graft of incompatible blood type, rituximab could be used to reduce the perioperative complications and improve the prognosis of recipient. After operation, the immunosuppression drugs should be minimized in order to decrease the drug associated side-effect. Despite many problems existing, the technique of LDLT will become more complete and secure, due to the advance of surgical skill as well as the anatomical structure of liver and the haemodynamics of graft being better known to surgeons. As an alternative approach for DDLT, LDLT will be used to treat more patients suffering from liver disease of end-stage in the future.