采用不含肝中静脉的右半肝行成人间活体肝移植

目的探讨采用不含肝中静脉的右半肝行成人间活体肝移植的可行性及安全性。方法2002年1月至2005年8月,我院施行了16例成人间右半肝活体肝移植,术中采用了不含肝中静脉的右半肝移植物,同时进行了一系列改良的手术技术包括肝右静脉的重建,右肝下静脉的重建,肝中静脉分支的搭桥等改进。结果全组供者无严重并发症及死亡。前2例受者中,1例发生肝静脉吻合口狭窄,1例因发生小肝综合征,死于肝功进行性恶化。后14例受者中发生并发症5例:急性排斥反应,肝动脉栓塞,胆漏,左膈下脓肿及肺部感染各1例;1例再移植术后肺部感染死于MODS。14例中除肝右静脉与下腔静脉(IVC)直接吻合外,其中5例加行右肝下静脉重建,另5例采用自体大隐静脉搭桥行肝中静脉分支与IVC重建,保证了右肝的流出道通畅。移植物与受者重量比(GRWR)为0.72%~1.15%,11例<1.0%,其中2例<0.8%,无小肝综合征发生。结论采用了改进的手术技术,特别是肝静脉流出道的充分重建可有效的避免小肝综合征,从而使采用不含肝中静脉的活体右半肝移植成为安全可靠的手术方式。

Adult-to-adult living donor liver transplantation using right lobe graft without middle hepatic vein

Objective To investigate the possibility and safety in adult-to-adult living donor liver transplantation using right lobe liver grafts without middle hepatic vein.Methods From January 2002 to August 2005,16 patients underwent living donor liver transplantation using right lobe grafts without middle hepatic vein.During operation,modifications were designed to improve the reconstruction of right hepatic vein,inferior right hepatic vein,and the reconstruction of the tributaries of the middle hepatic vein using interposition vein grafts.Results There were no severe complications and death in donors. For the first 2 recipients,one case developed stenosis of the right hepatic vein anastomoses,the other one developed small-for-size syndrome and died.For the later 14 cases,five complications occurred,including acute reject reaction(1 case),hepatic artery thrombosis(1 case),bile leakage(1 case),left subphrenic abscess(1 case),and pulmonary infection(1 case).The patient with pulmonary infection died of MODS.14 patients underwent direct anastomosis of right hepatic vein and IVC.Among them,5 cases underwent the reconstructions of right inferior hepatic vein,and 5 received the reconstruction of the tributaries of the middle hepatic vein by interpositing a vein graft to provide sufficient venous outflow.The graft and recipient weight ratio(GRWR) were 0.72%-(1.15%,) and no "small-for-size syndrome" occurred.Conclusions With modifications of surgical technique,especially the reconstruction of hepatic veins to provide sufficient venous outflow,living donor liver transplantation in adults using right lobe liver grafts without middle hepatic vein can(become) a relatively safe procedure and prevent the "small-for-size syndrome".