活体肝移植治疗胆道闭锁:22例单中心诊治经验

目的 总结活体肝移植治疗儿童终末期肝病胆道闭锁(BA)的外科治疗经验.方法 2006年6月至2009年7月,共完成亲属活体部分肝移植治疗胆道闭锁22例.术后平均随访18.5(1至36个月)个月,回顾总结肝移植患儿临床病理资料.结果 22例胆道闭锁患儿中已行Kasai手术9例,20例低于1岁,21例低于10kg.其手术平均时间、平均出血均无差别.供肝受体质量(GR/WR)比3.5(2.1～5.7)%.有27例次术后并发症,包括3例术后出血再手术止血,1例门静脉并发症,肝静脉并发症1例,3例肝动脉并发症,胆道并发症1例.有3例围手术死亡,1例再次移植,急性排斥5例(22.7%).6个月、1年和3年受体生存率分别为86.4%、82.2%和82.2%.结论 受体体重,移植物受体质量比,是否行Kasai手术对肝移植手术效果无影响;适当的供肝质量,细致的手术技巧可增加手术成功率.

Twenty two living related liver transplantation in children suffering from biliary atresia: a single centre experience

Objective To review our experience of living-related liver transplantation in children with biliary atresia (BA). Methods From June 2006 to July 2009,a total of 22 biliary atresia patients underwent living-related liver transplantation. The mean follow-up time was 18. 5 (1-36) months. We reviewed the outcomes of the transplantation. Results Of the 22 cases, 9 patients underwent Kasai procedure previously. Twenty of them were under 1-year of age and 21 weighed less than 10 kg at the time of transplant. There was no difference in the average duration of surgery and the amount of blood loss between patients of various age and weight. The average graft-to-recipient weight ratio (GW/RW)ratio was 3.5 (2.1-5.7) %. There were 27 cases of postoperative complications. These included 3bleeding requiring reoperation, 1 portal vein complication, 1 hepatic vein complication, 3 hepatic artery complications and 1 biliary tract complication. There were 3 cases of perioperative death, 1 case of retransplantation and 5 cases of acute rejection (22.7%). The 6-month, 1-year and 3-year actual recipient survival rates were 86.4% ,82.2% and 82.2% ,respectively. Conclusions The previous Kasai, operation,weight of recipients and GR/WR did not affect the outcome. Donor liver quality and meticulous surgical technique may improve the success rate of transplantation.