亲属活体单段供肝移植治疗极低体重婴儿胆道闭锁一例

目的 总结亲属活体单段供肝移植治疗极低体重婴儿胆道闭锁的临床经验.方法 受者为出生仅145 d的男婴,身高66 crn,体量3.08 kg,被确诊为胆道闭锁伴肝硬化.供者为患儿母亲,年龄36岁,身高145 cm,体重47 kg.采用改良背驮式原位肝移植术,切取供者Ⅱ段肝组织作为供肝,移植肝体积与受者标准肝体积比值为92.5%,GRWR为5.19%,供肝动脉与受者肝右动脉用供者左侧股外侧浅隐静脉搭桥行端端吻合,受者三支肝静脉经整合后与供肝静脉行端端吻合,供肝胆管与受者空肠行Roux-en-Y吻合.术后监测供、受者生命体征、肝肾功能及出血和凝血状况等,常规抗感染治疗.受者术后采用环孢素A、吗替麦考酚酯及甲泼尼龙的方案预防排斥反应.结果 供肝切取手术历时370 min,术中供者出血150 ml均回输,切取供肝重量为160 g.肝移植手术历时451min,术中受者失血230 ml,输注全血200 ml和红细胞悬液50 m1,无肝期时间为71 min,供肝冷缺血时间为132 min.供者恢复顺利,术后8 d拆线出院.受者术后5 d肝功能基本恢复正常,术后7 d各项化验指标均正常.但术后7和15 d时,受者分别发生肠道吻合口漏各1次,经修补后痊愈.受者于术后35 d出院,出院时体重增加0.3 kg,各方面与同龄婴儿相当.结论 亲属活体单段供肝移植是治疗极低体重患儿终未期肝病的一种可供选择的治疗方法,经充分的术前评估、精细的手术操作及良好的围手术期管理后,手术能取得良好效果.

Segmental living related liver transplantation for very small infant with biliary atresia

Objective To summarize the clinical experience of segmental living related liver transplantation for very small infant with biliary atresia. Methods The recipient was a 145-day-old male with congenital biliary atresia. The infant was 66 cm in height and weighed 3.08 kg. The donor was his 36-year-old mother. Her segment Ⅱ of the liver was excised and orthotopically transplanted into the infant's body as the graft. The portal vein of the graft was end-to-end anastomosed to the portal vein of the recipient, the hepatic artery of the graft was end-to-end anastomosed to the proper hepatic artery of the recipient with lateral superficial vein of left great saphenous vein from donor as a bridge, and the hepatic vein was end-to-end anastomosed to the hepatic vein of the recipient whose hepatic vein was conformed from right, middle and left hepatic vein. Biliary tract was reconstructed via Roux-en-Y operation. Results Segment Ⅱ (160 g) of liver from donor was resected, and there was no blood infusion. The donor retained her liver function within 5 days and was discharged on the eighth day. The operating time of graft implantation was 451 min. The blood loss was 250 ml. Non-liver stage was 71 min. The cold ischemic time was 132 min. Cyclosporine, mycophenolate mofetil (MMF) and prednisone were used for postoperative immunosuppression. The bilirubin level of the infant was decreased to the normal level one week after operation, and the liver function became normal in 9 days. Jejuno-leakage on the 7th day after the transplantation was recovered by mend and drainage and discharged on the 35th day. The donor and recipient were in satisfactory condition to present. Conclusion The segmental living related liver transplantation is advisable for very small infant with biliary atresia. Perfect operative technique and postoperative intensive care are the keys to ensure the success of the procedure.