小儿肝移植的探讨

目的本研究探讨肝移植治疗小儿终末期肝病的方法和疗效。方法我院分别于2001年11月至2002年12月对7例患儿(先天性胆道闭锁5例，先天性肝纤维化1例和肝脏血管内皮肉瘤1例)进行肝移植术，患儿年龄6个月至12岁。其中亲体部分肝移植术两例，供体分别为患儿的母亲和父亲。手术分别切取供体的右半肝和左外侧叶。受体行保留下腔静脉的全肝切除术，然后将供肝进行原位移植。减体积肝移植3例，取左半肝和左外侧叶为移植物。割离式肝移植2例，分别取左外后叶和右后叶为移植物。结果7例患儿分别移植肝重260～565g，亲体肝移植的两例供体随访14～15个月，均无并发症健康生活。接受移植的7例患儿中6例术后已经分别健康存活15～1个月，1例于术后第5天死于心功能衰竭。结论肝移植是治疗小儿终末期肝病的有效方法，术前准确的血管影像学检查，严格的围手术期管理特别是精确的手术技术是小儿肝移植成功的关键。

Liver transplantation in children with end-stage liver disease

Objective To evaluate the techniques and efficacy of liver transplantation for children with end-stage liver disease. Methods Liver transplantation was performed in 5 children with biliary atresia, 1 with congenital hepatic fibrosis and 1 with hepatohemoangioendotheliosarcoma in our hospital from November 2001 to December 2002. Their age ranged from 6 months to 12 years. Two of the 7 children underwent living related liver transplantation, and the right lobe and left lateral lobe grafts were transplanted from the mother and father of the recipients, respectively. In 3 cases, reduced size liver transplantation by using the left lobe and left lateral lobe was performed. The other 2 children received monosegmental graft (segment II) and right posterior segment graft, respectively, from the splitted liver. Results The weight of grafts in the 7 children ranged from 260g to 565 g. The 2 donors in the living related liver transplantation resumed to their pre-transplantation life soon after the operation without occurrence of any complication. Six of the 7 children have survived for 1-15 months now, and only 1 died from heart failure on the 5th d after the operation. Conclusions Liver transplantation can be an effective option to rescue lives of the children with end-stage liver disease. Accurate preoperative imaging determination, good perioperative ICU care and tedious surgical skills are critical for success of liver transplantation in children.