成人间活体肝移植94例报告

目的 探讨成人间活体肝移植供者评估、手术方式的选择及术后并发症分析.方法 收集2007年1月至2010年8月同一外科组施行的94例成人间活体肝移植的临床资料.受者年龄18 ～76岁,供者年龄19 ～60岁.94例活体肝移植手术方案包括:左半肝供肝移植2例,右半肝供肝移植92例,44例切取肝中静脉例,48例不切取肝中静脉.分析供受者术前评估、术后并发症及存活情况.结果 所有供者均恢复良好出院,供者并发症发生率为7.4％.随访截止于2011年5月31日,中位随访时间为37个月,死亡8例.供者1年存活率为95.7％,移植物存活率为94.7％.1例发生小肝综合征;1例因急性肝坏死行再次肝移植;24例(25.5％)经胆道造影或磁共振胰胆管成像检查发现胆道吻合口狭窄,但其中9例(9.6％)表现为肝功能异常.结论 活体肝移植是治疗终末期肝病的有效方法,精确的术前评估、合理手术方式选择,采用左半肝或右半肝供肝、含或不含肝中静脉的活体肝移植,在成人间活体肝移植中均能有效的保证供受者安全.

Adult-to-adult living donor liver transplantation with 94 cases report

Objective To investigate the donor evaluation,surgical protocol,and the complication for the adult-to-adult living donor liver transplantation (AALDLT).Methods There were 94 cases of AALDLT were performed by the same surgical team from January 2007 to August 2010.Patients aged from 18 to 74 years.Donors aged from 19 to 60 years.All the 94 cases' operation protocol as following,2 cases with left lobe liver graft,92 cases with right lobe graft,44 cases with middle hepatic vein(MHV) harvested,and 48 cases without MHV.Assessment methods of donors,postoperative complications and the current survival were analyzed.Results All the donors were discharged with good recovery,complication incidence of donor was 7.4％.Median time of follow-up was 37 months.Eight patients were died during follow-up,1- year patient survival rate was 95.7％,and graft survival rate was 94.4％.One case complicated with smallfor-size syndrome,1 case was performed re-tranplantation for acute hepatic necrosis,24 patients( 25.5％ )showed biliary anastomotic stenosis defined cholangiography or magnetic resonance cholangiopancreatography examination,and 9 patients ( 9.6％ ) showed abnormal liver function.Conclusions Living donor liver transplantation is an effective treatment method for end-stage liver disease,with accurate evaluation preoperative,a reasonable surgical approach,whether using the left or right lobe liver graft,with or without middle hepatic vein in AALDLT can effectively ensure the donor and recipient safety.