超吸刀结合氩气刀在活体肝移植中的应用

背景：活体肝移植供者的安全令人关注,供肝切取过程复杂、技术要求高、难度大,因而移植中减少出血量和副损伤是减少并发症发生率的关键。目的：观察活体肝移植过程中超吸刀结合氩气刀应用的优势。方法：回顾昆明市第一人民医院移植中心自2006-05/2010-10应用超吸刀结合氩气刀开展的26例活体肝移植,其中13例使用右半肝,9例使用左半肝,4例使用双供肝。活体供者年龄22～63岁。通过对供肝切取过程中的失血情况及供者术后相关并发症的观察,总结应用超吸刀及氩气刀进行供肝切除的优势。结果与结论：无供者死亡,且无供者因出血等原因而二次手术,仅有1例供者移植后出现胆瘘,充分引流后痊愈。右半供肝切取平均失血683mL,输血820mL,切除肝质量平均为530g。在活体肝移植供肝切取中应用超吸刀及氩气刀不仅可以缩短移植时间,减少移植损伤,同时也能够降低移植后并发症的发生率,因此联合应用超吸刀及氩气刀是一种安全而有效的供肝切取方法。

Application of cavitron ultrasonic surgical aspirator and argon plasma coagulation in living-donor liver transplantation

BACKGROUND：Safety of donors in living-donor liver transplantation （LDLT） has aroused great attention due to complex surgery and high specification. Accordingly,how to minimize hemorrhage and light damage plays a key role in transplantation. OBJECTIVE：To discuss advantages of utility of cavitron ultrasonic surgical aspirator （CUSA） and argon plasma coagulation （APC） in the living-donor liver transplantation. METHODS：Totally 26 cases LDLT which used CUSA and APC in operations were retrospectively analyzed; in these cases,13 cases used right lobe graft,9 cases used left lobe graft,and 4 cases were double-donor living donor liver transplantation. Ages of donors ranged from 22 to 63 years. By observing blood loss volumes in operations and donors＇s complications,the advantages of CUSA and APC usage in donors＇s hepatectomies in LDLT were concluded. RESULTS AND CONCLUSION：There was no donor died,and no donor received a second operation because of bleeding or other reasons. Only 1 donor presented with biliary fistula after operation,and recovered by complete drainage. The average blood loss volume in right lobe hepatectomies was 683 mL,mean volume of blood transfusion was 820 mL. Mean weight of grafts was 530 g. Usage of CUSA and APC in the LDLT not only reduce operation time,but also minimize side injury of hepatectomy. Meanwhile,incidence rate of postoperative complications can be reduced. Therefore,usage of CUSA combined with APC in LDLT,especially in donors＇ hepatectomy,is safe and effective.