成人间活体右半肝肝移植24例报告

目的 探讨成人间活体右半肝肝移植的可行性及安全性。方法 自2002年1月至2005年12月,施行了24例成人间右半肝活体肝移植,术中采用了一系列改良的手术技术,包括右肝静脉的重建,右下肝静脉的重建,肝中静脉分支的搭桥,肝动脉塔桥及胆道吻合等改进措施。效果良好。结果 全组供体无严重并发症及死亡。前阶段2例受体中,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22例,受体发生并发症7例,包括急性排斥反应2例,肝动脉栓塞,肠肠吻合口出血,胆漏,左膈下脓肿及肺部感染各1例,其中1例再移植因术后肺部感染,多器官功能衰竭死亡。22例中除右肝静脉与肝后下腔静脉直接吻合外,其中9例加行右肝下静脉重建,另10例采用自体大隐静脉搭桥行肝中静脉分支与IVC重建,保证了右肝的流出道通畅。移植物与受体重量比为0.72％～1.17％,19例〈1.0％,其中4例〈0．8％,无小肝综合征发生。结论 采用了改进的手术技术,特别是肝静脉流出道的充分重建可有效的避免小肝综合征,从而使活体右半肝移植成为相当安全的手术。

Adult-to-adult living donor liver transplantation using right lobe graft: report of 24 cases

Objective To investigate the safety and feasibility of adult-to-adult living donor liver transplantation (A-A LDLT) using right lobe graft. Methods From January 2005 to December 2005, 24 patients, 22 males and 2 females, aged 20~53, with the underlying diseases of liver cirrhosis, hepatocellular carcinoma, and Budd-Chiari syndrome, underwent A-A LDLT using right lobe graft. During the second period, including 22 cases, modified techniques were adopted, e.g. direct anastomosis of the right hepatic vein (RHV) and inferior vena cava was performed in all 22 cases, reconstruction of inferior right hepatic vein was performed on 9 cases, and reconstruction of tributaries of middle hepatic vein by interposing a vein graft on 10 cases so as to provide sufficient venous outflow. Results No sever complication and death was found in the donors. The graft and recipient weight ratio was 0.72%~1.17%, being <1.0% among 19 cases and being <0.8% among 4 cases. During the first period one of the 2 patients suffered from stenosis at the anastomotic stoma of the right hepatic vein, and the other patient suffered from small-for-size syndrome and died. During the second period modified techniques were adopted and no more small-for-size syndrome occurred. Conclusion With the modified techniques, A-A LDLT has become a relative safe procedure.