活体肝移植22例临床分析

目的 总结开展活体肝移植的临床经验,探讨进一步提高活体肝移植疗效的措施.方法 回顾性分析我院22例活体肝移植供受体的临床资料,总结术前评估过程、手术方法和术后并发症的情况.结果 本组获取的供肝移植物包括左外叶2例、左半肝6例、扩大左半肝1例、右半肝5例和扩大右半肝8例.所有供体术后恢复顺利,未出现严重并发症.22例受体中成年患者13例,儿童患者9例.围手术期发生并发症8例,包括严重腹腔感染1例,肝功能恢复不良合并伤口感染1例,腹腔内出血继发肝动脉血栓形成1例,此3例患者最终均因多器官功能衰竭死亡.1例肝功能衰竭的患儿术后因心肺功能衰竭死亡.另外发生胆漏2例,顽固性腹水1例,右下肢深静脉血栓形成1例,均通过保守疗法治愈.18例受体病愈出院.手术后期发生胆道吻合口狭窄3例,行PTCD并留置支撑管治疗,Oddi括约肌失迟缓引起的梗阻性黄疸1例,行内镜下十二指肠乳头括约肌切开术治疗.此4例患者病情稳定,肝功能均已恢复正常.结论 选择合适的供体、掌握关键的手术技术,才能使供受体都获得良好的预后.

Living donor liver transplantation: a reeort of 22 cases

Objective To summary the experience of living donor liver transplantation (LDLT) in order to improve therapeutic effect of LDLT. Methods We retrospectively analyzed the clinical data of donors and recipients of 22 LDLT cases, evaluating patients' and donors' preoperative assessment, surgical strategies and postoperative complications. Results Donor's grafts harvested included 2 left lateral lobes, 6 left half livers, 1 extended left half liver, 5 right half livers and 8 extended right half livers. Postoperatively all donors recovered without severe post-transplantation complications. Among 13 adult and 9 child receipients, there were 8 recipients suffering from posttransplantation complications, including intra-abdominal severe infection in one case, delayed liver function recovery complicating incisional infection in one case, intra-abdominal hemorrage complicating thrombogenesis of the hepatic artery in one case. All these 3 patients died. One child recipient of hepatic failure died of heart and respiratory failure after operation. Other non-lethal complications were bile leakage in 2 cases, refractory ascites in one and deep venous thrombosis of the lower limb in one. These complications were cured without laparotomy. Finally 18 recipients were fully recovered and discharged. Late post-operative complications included strictures of biliary tract in 3 cases which were treated with PTCD and indwelling stent, the obstructive jaundice due to achalasia of sphincter of Oddi was treated with endoscopic sphincterotomy. These 4 patients' are on stable condition and the liver function is normal. Conclusions Select proper donor and optimal surgical strategy are extremely helpful to secure donors and recipients during the procedure of LDLT.