常规及新肝移植手术的现状

背景：经典术式和背驮式肝移植是目前肝移植的常规术式。 目的：对目前肝移植的常规术式及新术式的发展及特点进行总结。 方法：检索1900-01/2011-01 Pubmed、CNKI及肝移植注册网中与肝移植术式相关的文献,筛选出的35篇肝移植临床研究、综述、报告等文献进行分析。 结果与结论：初检得到1 251篇文献,根据纳入标准保存35篇文献进行分析。经典术式和背驮式肝移植是目前的常规术式。新的移植术式不断出现：劈离式肝移植“一肝两受”,节约肝源;活体肝移植取自活体肝,使用灵活,发展较快;自体肝移植难度大,应用少;多米诺肝移植能够有效治疗FAP,但也因难度大开展不多;肝细胞移植和异种肝移植基础研究尚浅。常规术式技术较为成熟,因在利用供肝、开拓肝源方面的优势,新的移植术式应用前景广阔,但仍需手术技术和基础研究上的突破。

Conventional and new surgical approaches to liver transplantation

BACKGROUND:Liver transplantation is an important method in the treatment of the end-stage liver diseases and hepatic carcinoma, but nowadays the donors are more and more decreased, which are the choke point of the liver transplantation. The development of the surgery approaches of the liver transplantation can support to utilize the grafts and broaden the donors effectively. OBJECTIVE:To provide references for the clinicians to carry out liver transplantation and study the approaches through reviewing the developments and characteristics of conventional and new surgical approaches in liver transplantation. METHODS:Pubmed database, CNKI database and some liver transplantation registries were retrieved for the relate literatures of surgery approaches published between January 1900 and January 2011. Then, 35 literatures of clinical studies, reviews and reports were analyzed. RESULTS AND CONCLUSION:Totally 1 251 articles were obtained in initial retrieval, of which 35 articles were chosen to be analyzed based on the inclusion criteria. Standard orthotopic liver transplantation and Piggyback liver transplantation were conventional, and new approaches were emerging. Split liver transplantation could be realized for providing a graft to two recipients. Living donor liver transplantation could be used flexibly and developed rapidly. Liver autotransplantation was very difficult in the techniques, so it was rarely used. Domino liver transplantation could be used to treat FAP effectively, but it was also rarely used due to difficulties in the technology. Hepatocytes transplantation and liver xenotransplantation were not sufficiently studied. Conventional surgical technologies have been well mastered because of the advantages in utilizing the grafts and extending the source of grafts. New approaches have broad application prospects, but need the breakthroughs in surgical techniques and basic research.