体外劈离式肝移植22例临床分析

目的 总结22例体外劈离式肝移植的临床经验.方法 回顾性分析2006年6月至2010年1月间22例劈离式肝移植的临床资料,第一阶段(2006年6月至2(D7年2月)移植10例,第二阶段(2009年1月至2010年1月)移植12例.共对11例供肝进行劈离,获得22个移植物,其中超右半肝8个,左外侧叶肝8个,含肝中静脉的右半肝3个,不含肝中静脉的左半肝3个.观察术后移植肝功能的恢复情况、血管和胆道并发症的发生率及受者的存活率.结果 22例受者术后中位随访时间为11.7个月(0.5～43个月),术后1年和3年累积存活率分别为82%和63.7%.动脉并发症的发生率为9.1%,胆道并发症发生率为33.3%.22例受者中有5例死亡,其中2例的死亡原因与外科技术并发症相关,但均为第一阶段移植的受者.结论 随着供肝劈离技术和部分肝移植技术的进步,体外劈离式肝移植的受者和移植肝的存活率与全肝移植相近.应在我国推广此技术,从而增加供肝数量.缩短受者等待移植的时间.

A clinical report of 22 cases of ex vivo split-liver transplantation

Objective To summarize clinical experience in 22 cases of ex vivo split-liver transplantation (SLT). Methods A retrospective analysis was conducted on 22 cases of SL T performed during June 2006 to January 2009. Ten cases were performed at the first phrase (2006. 6-2007. 2), and 12 cases were performed at the second phrase (2009. 1-2010. 1 ). Eleven cadaveric donor livers received ex vivo splitting, and 22 grafts were yielded: 8 cases of extended right lobe, 8 cases of left lateral lobe, 3 cases of right lobe (including middle hepatic vein), and 3 cases of left lobe. The survival rate of patients, recovery of liver function, incidence of vascular complications and biliary complications were observed. Results The median follow-up time of all the patients was 11.7 months (0. 5-43 months). The 1-and 3-survival rate was 82% and 63. 7 % respectively. The incidence of arterial complications was 9. 1%, and biliary complication rate was 33.3 %. Five recipients died, of which 2 cases were related to surgery technology complications. Conclusion With technical improvements and refinements in partial liver transplantation and SLT, SLT can expand the current cadaveric donor pool.