成人间活体肝移植治疗终末期肝病

目的探讨成人间活体肝移植治疗终末期肝病的方法及技术要点。方法回顾性分析2000年9月—2004年9月成人间活体肝移植9例患者的临床资料。其中,左半肝(第、、段,包括肝中静脉)移植3例,右半肝(第、、、段,不包括肝中静脉)移植6例。结果9例供体无手术死亡,平均手术时间(6.2±1.4)h;术中出血300~1200ml;术后胆漏1例,切口脂肪液化1例;随访6~12个月,无远期并发症,全部于术后1~2个月恢复工作。受体手术时间5~11h;采用改良方法重建移植肝流出道、显微技术重建肝动脉、端端吻合重建胆道;术中出血800~7000ml;移植物冷缺血时间(1.9±0.5)h;无肝期时间(98±26)min;移植物重量与受体体重比为(1.20±0.26)%。受体术后并发腹腔内局限性胆漏1例;死亡1例,长期存活8例。结论成人间活体肝移植是解决供肝短缺、治疗终末期肝病的有效方法,同时能相对保证供体的安全;管道重建是手术成功的关键。

Adult to adult living donor liver transplantation for decompensated end-stage liver disease

OBJECTIVE: To summarize the clinical experience and some principal surgical techniques of adult to adult living donor liver transplantation (ALDLT). METHODS: The clinical data of 9 patients receiving ALDLT from September 2000 to September 2004 in liver transplantation center in the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively. The left lobe (segments II, III, IV, including the middle hepatic veins) was transplanted in 3 patients, and the right lobe (segments V, VI, VII, VIII, not including the middle hepatic veins) was transplanted in 6 patients. RESULTS: There was no operative death in donors. The median operative time was (6.2+/-1.4) hours. The blood loss ranged from 300 to 1,200 ml. Postoperative complications included biliary fistula (1 donor) and wound fat liquefaction (1 donor). They were followed up for 6-12 months, and no long term complications were found. In recipients, the operating time ranged from 5 to 11 hours. The blood loss ranged from 800 to 7,000 ml. Modified outflow reconstruction method, microvascular reconstruction of the hepatic artery and duct to duct biliary reconstruction were performed in recipients. The median cold ischemic time of the grafts was (1.9+/-0.5) hours. The mean non hepatic stage of recipients was (98+/-26) minutes. Graft/recipient weight ratio (GRWR) was (1.20+/-0.26)%. One recipient presented postoperative complication of biliary fistula. One recipient died of serious infection 1 month postoperatively. The other 8 recipients enjoyed longterm survival. CONCLUSION: The procedure of ALDLT is an effective method in the treatment of decompensated end stage liver disease, and it is relatively safe for the donor. Reconstruction of vessels is the key surgical technique in the operative procedure.