原位肝移植供肝撕裂伤的处理

目的 探讨原位肝移植供肝获取过程中发生撕裂伤的处理方式.方法 对2018年2月至2021年1月清华大学附属北京清华长庚医院297例原位肝移植手术中供肝撕裂伤的情况进行回顾性分析.对供肝撕裂伤进行分级分度:包膜撕裂<2 cm为A级,≥2 cm但<5 cm为B级,≥5 cm为C级;无明显肝实质裂伤即肝实裂深度<1 mm为I...

Management of graft laceration in orthotopic liver transplantation

Objective To investigate the management of graft laceration during organ procurement in orthotopic liver transplantation (OLT). Methods The incidence of liver laceration in 297 patients who received OLT from Feb. 2018 to Jan. 2021 in Beijing Tsinghua Changgung Hospital was analyzed retrospectively. Classification and degree of liver laceration were set as capsule tear area: <2 cm was level A, ≥2 cm but <5 cm was level B, ≥5 cm was level C. No obvious liver parenchymal laceration (depth <1 mm) was grade I°, depth ≥1 mm but <5 mm was grade II°, and ≥5 mm was grade III°. Damage control and surgical results were recorded. Results Among 297 patients, 31 cases (10.4%) had donor liver laceration. The graft liver injury rate of cardiac death donor was significantly higher than that of brain death donor [14.7% (19/129) vs 7.1% (12/168),P<0.05]. More injury occurred in the right liver than in the left (26 cases vs 5 cases, P<0.05). The degree of laceration was 15 cases in level A, 12 cases in level B, and 4 cases in level C. There were 18 cases with grade I° laceration, 10 cases with grade II° laceration, and 3 cases with grade III° laceration. U-shape suture was used in 14 cases of lacerations, and capsular application+U-shape suture was used in 8 cases. Capsular application effectively reduced the bleeding of level C or grade III° graft laceration. Conclusion Based on level and grade of injury, U-shape suture or capsular application+U-shape suture can effectively treat liver lacerations caused by donor liver procurement surgery in OLT and can reduce the risk of intraoperative bleeding.