成人活体肝移植供肝的修整经验报告  

Back-stage procedures for live donor liver transplant:a single center experiences

作　　者：蔡金贞[1] 郑虹[1] 邓永林[1] 潘澄[1] 张雅敏[1] 蒋文涛[1] 淮明生[1] 孟醒初[1] 郭庆军[1] 沈中阳[1] 

机构地区：[1]天津市第一中心医院,天津,300192

出　　处：《实用器官移植电子杂志》2013年第6期-,共5页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：国家自然科学基金资助项目(81170443)；天津市医药卫生科技基金项目

摘　　要：目的：报告活体肝移植供肝后台的修整经验，为肝移植手术的成功提供依据。方法回顾分析天津市第一中心医院2006年9月至2009年5月间完成的230例活体肝移植供肝后台准备的资料。结果230例供肝中：含肝中静脉右半肝117例；含部分肝中静脉3例；不含肝中静脉右半肝102例；含肝中静脉及尾状叶的左半肝3例；左外侧叶5例。102例不含肝中静脉右半肝重建肝右后下静脉（IRHV）5例，117例含肝中静脉右半肝重建IRHV 16例，两组间存在显著差异（P＝0.045）。102例不含肝中静脉的右半肝中：11例肝右静脉（RHV），6例RHV+IRHV，75例RHV+V5/8，10例RHV+V5/8+IRHV。81例V5/8采用不同材料重建静脉：新鲜尸体髂静脉77例，受体大隐静脉1例，受体曲张脐静脉1例，受体肝内门静脉1例，受体肝静脉1例。222例右半肝供肝中门静脉为C型的9例，均成型为一个开口，D型1例采用髂血管成型为一支。肝动脉单支者226例，双支者为4例，2例采用动脉重建。结论活体肝移植供肝后台修整在供肝灌洗保存的同时，对供体的肝动脉、门静脉及流出道恰当的成型或重建有利于简化供肝植入的步骤，保护肝脏的功能组织，是手术成功的关键。Objective To summarize the experiences of back-stage procedures for living donor liver graft, and to provide the experience of liver transplantation. Methods The data from 230 cases of back-stage procedures of living donor graft in Tianjin First Center Hospital from September 2006 to May 2009 were reprospectively reviewed. Results A total of 230 grafts were harvested.Graft type included:right liver graft with the middle hepatic vein in 117 cases,the inferior right hepatic vein(IRHV)was reconstructed in 5 out of 117 cases,with partial middle hepatic vein in 3 cases;right liver graft without the middle hepatic vein in 102 cases,the IRHV was reconstructed in 16 out of 102 cases;left liver graft with the middle hepatic vein and caudate in 3 cases;left lateral lobe in 2 cases. There was significant difference between two group(P=0.045). In 102 cases of right liver graft without the middle hepatic vein:right hepatic vein(RHV)in 11 case,RHV+IRHV in 6 cases,RHV+V5/8 in 71 cases,RHV+V5/8+IRHV in 10 cases,V5/8 in 81 cases. In some cases different materials were used to reconstruct the hepatic vein:including cold-storage cadaveric iliac veins in 77 cases,great saphenous vein in 1 case,varicose umbililical vein in 1 case,recipient intrahepatic portal vein in 1 case and recipient intrahepatic vein in 1 case. Among the 222 right grafts,type C portal vein was identified in 9 cases and venoplasty was performed to incorporate 2 portal veins into a single orifice.1 case of type D was venoplastied into one orifice with iliac vein. There were 226 cases with single hepatic artery and 4 cases with two hepatic artery. Conclusion The venoplasty and reconstruction of donor graft hepatic artery,portal vein and outflow in the protection of preservation solution can simplify implanted procedure,preserve hepatic function and it is important for postoperative recovering of the recipients.

关 键 词：肝移植 活体捐献 静脉成形术 

分 类 号：R65[医药卫生—外科学] R73[医药卫生—临床医学]