成人间活体肝移植后小肝综合征的预防：附6例报告

目的：探讨预防成人间活体肝移植术后小肝综合征（SFSS)的方法。 方法：回顾性分析6例成人间活体肝移植(LDLT)的临床资料，包括受体术前血细胞计数、脾脏厚度、门静脉直径、移植物重量与受体体重比（GRWR）、移植物体积与受体标准肝体积比（GV/SLV）及肝静脉重建等，探讨合适体积移植物、良好肝静脉回流、及正常门静脉灌注对SFSS的预防作用。 结果：受体术前均无严重门静脉高压，均没有采用降门静脉压力与血流的措施，6例肝移植物GV/SLV均大于40%，除1例GRWR为0.74%外，余均大于0.8%。6例受体肝静脉重建均良好，重建后肝脏无淤血改变。术后无SFSS发生。 结论：LDLT通过选择合适体积移植物，重建良好的肝静脉回流，控制门静脉压力，防止门静脉过度灌注等有助于预防SFSS的发生。

Prevention strategies for small-for-size syndrome in adult-to-adult living-related liver transplantation:a report of 6 cases

Objective:To explore the methods to prevent small-for-size syndrome(SFSS) in adult-to-adult living-related liver transplantation(A-A LDLT). Methods :The clinical data of 6 cases of A-A LDLT performed in our hospital between February 2007 to October 2008 were retrospectively analyzed,including blood cell count, spleen thickness, diameter of portal vein in recipients before operation,graft recipient body weight ratio(GRWR),graft volume and standard liver volume ratio of receptor(GV/SLV),and hepatic vein reconstruction. Results:Of the six grafts,the GV/SLV was more than 40%,the GRWR was always above 0.8% except one case was 0.74%. All the recipient grafts had good hepatic vein reconstruction,with no congestion in the grafts;of the six recipients no severe portal hypertension was observed, and no SFSS occurred in the six cases. Conclusions: The occurrence of SFSS can be prevented by selecting the appropriate graft size, adequate venous blood drainage through hepatic veins, and control of the portal pressure.