50例成人活体肝移植分析

目的 探讨成人间右半肝移植中如何保证供、受体的安全.方法 分析2002年1月至2006年7月施行的50例成人活体右半肝移植,包括47例不含肝中静脉(MHV)的右半肝移植及3例双供肝肝移植.受体原发病主要包括:乙肝肝硬变30例(60%,含急性肝衰12例),肝细胞肝癌15例(30%).供体常规行三维CT计算全肝体积及右半肝体积,对供、受体采用了一系列术前评价及手术技术改进.结果 52例供体共摘取49例右半肝及3例左半肝,49例右半肝均不含肝中静脉,质量为400～850 g(中位质量550 g),与受体标准肝质量比为31.74%～71.68%(平均45.35%),供体残肝体积均大于全肝体积的35%.52例供体发生并发症4例(7.69%),无死亡,术后住院时间7～30d(中位11d).50例受体(含3例双供肝受体),随访2～52个月(中位9个月),发生并发症13例(26%),4例(8%)死亡,1年实际生存率92%.结论 采用不包含MHV的右半肝移植术,术前CT测量残肝体积＞35%和右半肝移植物与受体标准肝质量比＞40%,是保证供、受体安全的有效指标.

Analysis of Fifty Adult to Adult Living Donor Liver Transplantation

OBJECTIVE: To investigate the safety of adult-to-adult living donor liver transplantation (AALDLT), which means how to make the life safeties of both adult donor and recipient who are transplanted with the right lobe of liver. METHODS: From January 2002 to July 2006, 50 A-ALDLT were performed at West China Hospital, Sichuan University, which consisted of 47 cases with right lobe graft without middle hepatic vein (MHV) and 3 cases with the dual graft of liver lobes (one cases with two left lobes, 2 with one right and one left lobe). The majority of adult liver recipients suffered originally from the hepatitis B with liver cirrhosis (60%), hepatocellular carcinoma (30%) as primary diseases, and 10 cases among them had the model of end-stage liver disease (MELD) score more than 25. The grafting livers of donors were routinely scanned under three-dimensional computed tomography (CT), and the scan image data were computed for volume reconstructions of whole and right lobe livers. Various innovative surgical techniques were adopted for donor and recipient procedure operation. RESULTS: From 52 living donors, 49 right liver lobes and 3 left lobes were obtained. The 49 right lobe grafts without MHV were weighed to 400-850 g (medial 550 g). The ratios of the graft volumes to the volumes of recipient standard livers (GV/SLV) were ranged from 31. 74% to 71. 68% (mean, 45. 35%). All of the donor remnant liver volumes were larger 35% of the whole liver volume. There was no donor mortality occurring, but 7. 69% of donors undergoing complications in 50 adult recipients. With postoperatively following up 2-52 months (medial 9 months), 13 (26%) occurred various complications and 4 (8%) died within 3 months. Their 1-y actual survival rate was 92%. CONCLUSION When preoperative CT volume showed the volume of remnant liver is greater than 35% of whole liver volume, and the ratio of right lobe graft volume to recipient's standard live volume is more than 40% , A-ALDLT using right lobe graft should be very safe procedure for both donors and recipients, otherwise the dual graft liver transplantation should be considered.