活体供肝肝移植成功的初步经验--附3例报告

目的 报告3例活体供肝肝移植成功的初步经验。方法 回顾性分析1例肝细胞癌伴肝硬化、1例先天性肝内胆汁淤积症及1例药物性肝炎病人活体供肝肝移植经过和供受体恢复情况。结果 供肝均取自病人父亲，1例为右半肝，另2例为扩大左外叶，供肝重量分别为835g、295g及320g。第1例供体术后有一过性黄疸，且有轻度胆漏，另2例供体术后恢复顺利，无手术并发症。3例病人手术均顺利，1例成人一成人活体供肝肝移植胆道重建为胆管端端吻合，术后定期行全身化疗预防肿瘤复发。2例成人-儿童活体供肝肝移植胆道重建为胆管、空肠Roux-en-Y吻合。3例病人均行肝静脉整形以保证静脉回流通畅。随访至今，供受体已分别健康生存16、14、13个月。结论 严格的病例选择，完善的术前准备，精细的手术操作及正确的术后处理是活体供肝肝移植成功的关键。

Primary experience in living donor liver transplantation:a report of 3 cases

Objective To review the primary experience in living donor liver transplantation (LDLT) in 3 cases. Methods Three cases receiving LDLT for hepatocellular carcinoma (HCC) with severe cirrhosis, congenital intrahepatic cholestasis and drug-related hepatitis, respectively, were retrospectively analyzed and the outcomes of donors and recipients reviewed. Results The grafts all came from the patients' fathers. The graft type was right lobe in the first case extended left lateral segment in other 2. The graft weight was 835 g, 295 g and 320 g in the 3 cases, respectively. The donor for the first case suffered from temporarily postoperative jaundice and mild bile leakage and the other 2 donors and all recipients successfully recovered. The biliary reconstruction was performed with duct-to-duct anastomosis in one case of adult-to-adult LDLT but standard Roux-en-Y anastomosis in other 2 cases. The recipients with HCC received regular systemic chemotherapy to prevent tumor recurrence. All the 3 recipients underwent hepatic vein reconstruction to facilitate venous drainage. The followed-up study till now showed that the recipients and donors have survived for 16, 14 and 13 months in good health, respectively. Conclusions Strict selection of indications, perfect preoperative preparation, subtle operative manipulation and proper postoperative management are important for successful LDLT.