背驮式肝移植──连续成功9例的经验体会

目的　总结连续 9例背驮式肝移植 (POLT)的经验。　方法　从 1 999年 8月 31日开始施行首例肝移植至 2 0 0 1年 1月 31日连续进行了肝移植 9例。全部使用彭氏多功能手术解剖器 (PMOD)施行 ,9例中 2例为Caroli病 ;3例为肝细胞性肝癌 ;1例为肝糖原累积症I型伴多发性肝腺瘤 ;1例为硬化性胆管炎 ;2例为晚期肝硬化。 9例中除 1例行静脉转流辅助外 ,其余 8例均未行转流。供肝的流出道均采用受体的肝中肝左静脉共干与供肝的肝上下腔静脉端端吻合。胆道重建除 1例行胆管空肠Roux Y吻合外 ,其余 8例均为胆道端端吻合并于吻合口远端置T管 ,其近端超过吻合口 ,作为支撑管之用。　结果　 9例全部存活 ,首例至今已近 1 8个月。除 2例新近手术后仅 1 1天者外 ,其余 7例均自理生活 ,其中第 2例于术后 2月就恢复工作。　结论　背驮式肝移植术适用于绝大多数接受肝移植的患者。使用PMOD采取刮吸解剖法有助于POLT的开展。

Piggyback Orthotopic Liver Transplantation (A Report of 9 Cases)

Objective To summarize the experiences on piggy back orthotopic liver transplantation(POLT). Methods The authors performed orthotopic liver transplantation (OLT) for the first time in this hospital on 31 Aug 1999. Since then all together 9 consecutive cases have been treated with POLT by the authors successfully. The operations were carried out by means of Peng's Multifunctional Operative Dissector (PMOD) with the technique named Curettage and Aspiration. POLT was employed for all the 9 cases (2 Caroli disease,3 hepatocellular carcinomas, 1 glycogen storage syndrome,1 sclerosing cholangitis,2 end stage liver cirrhosis). Venous bypass was only used in one case. Suprahepatic inferior vena cava (IVC) of the homograft was end to end anastomosed to the common trunk of middle and left hepatic vein for all the cases. Billiary reconstruction were carried out with end to end anastomosis of the bile ducts with a T tube retained for a few months as a stent in all the cases except one case whose bile duct reconstruction was achieved with Roux Y hepato jejunostomy. Results All the cases are surviving well, the first case being alive for nearly 18 months. The second case resumed his job as a sales manager 2 months after the operation. Conclusions POLT can be employed for the majority of OLT candidates. The technique of Curettage and Aspiration with the use of PMOD is very helpful in carrying out POLT.