摘要
目的 探讨活体肝移植的几点关键外科技术。 方法 2 0 0 1年 1月至 2 0 0 2年 3月底 ,实施活体肝移植 11例 ,其中左半肝 8例 ,左外叶 1例 ,成人右半肝 2例 ;根据术前CT、血管造影和术中B超确定肝切除线 ,超声电刀离断肝实质 ,经门静脉灌注原位获取。受体手术采用保留腔静脉的全肝切除。移植肝原位植入 ,肝静脉重建采用扩大成型吻合技术 ,显微技术吻合肝动脉 ,胆道重建采用端端吻合 ,置“T”管引流。 结果 11例供体术后顺利康复出院 ,未发生严重并发症。 11例受体中 ,1例发生肝动脉血栓形成需再次肝移植 ,1例因不可逆转的严重排斥反应 ,于术后 72d死亡。 10例受体康复出院 ,肝功能、铜氧化酶恢复正常。 结论 活体肝移植对供体是相对安全的。管道重建技术是活体肝移植的重要环节。术前、术中了解供体的解剖变异并正确处理 ,可降低并发症发生率。
Objective To investigate some principal surgical sechniques of living donor liver transplantation(LDLT). Methods Eleven patients of LDLT have been performed at our department from January 2001 to March 2002. The left lobe (segments Ⅱ, Ⅲ, Ⅳ, including the middle hepatic veins) was transplanted in 8 patients, the left lateral lobe(segments Ⅱ, Ⅲ) in one and the right lobe (segments Ⅴ, Ⅵ, Ⅶ, Ⅷ, not including the middle hepatic veins) in 2. The plane of liver resection was determined on the basis of donor liver volumetry using CT scan and the anatomic analysis of vascular structure of the hepatic vein, portal vein and hepatic artery using intraoperative ultrasound. The hepatic parenchyma was transected using ultrasound aspirator without blood vessel clamping or graft manipulation. The isolated graft was perfused in situ through the portal vein branch. The liver graft was transplanted into the recipients who underwent total hepatectomy with preservation of the inferior vena cava. The hepatic vein reconstruction was performed in end to end fashion or end to side to the vena cava after venoplasty. Arterial anastomoses were performed using microsurgical technique. Biliary reconstruction was made by using duct-to-duct anastomosis and placement of a T tube. Results All the 11 donors are uneventfully discharged after operation. In the 11 recipients, an 8-year-old girl needed retransplantation because of hepatic artery thrombosis, one case died of serious chronic rejection on the postoperative day 72. Ten recipients recovered and were discharged from hospital, whose liver function and cuprum oxidase had returned to normal. Conclusions The procedure of LDLT is relatively safe for the donor. Reconstruction of vessels is a key step in the procedure. Comprehending anatomical variation of vessels pre- and intra-operatively and correct surgical management might reduce the incidence of complications.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2003年第1期13-16,共4页
Chinese Journal of Surgery
基金
江苏省重点课题 (BJ980 2 5 )
江苏省青年基金课题(BQ980 12 )
江苏省卫生厅课题 ( 45 5EA95 0 2 )基金资助
关键词
肝移植
活体供者
显微外科手术
术后并发症
Liver transplantation
Living donors
Microsurgery
Postoperative complications
