减体积肝段移植治疗儿童胆管闭锁1例报告  

The reduced left monosegment liver transplantation in treatment of pediatric biliary atresia:case report

作　　者：李江[1] 蔡金贞[1] 郭庆军[1] 李俊杰[1] 孙晓叶[1] 沈中阳[1] 

机构地区：[1]天津市第一中心医院器官移植中心,天津300192

出　　处：《实用器官移植电子杂志》2014年第5期299-303,共5页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：国家高技术研究发展计划(863)项目(2012AA021001);国家自然科学基金项目(81400680)

摘　　要：目的报道1例减体积肝段移植治疗儿童先天性胆管闭锁的病例。方法回顾性总结天津市第一中心医院2014年3月为1例先天性胆管闭锁的患儿进行的亲属活体肝移植术,患儿年龄5个月,体重7 kg,供体为患儿母亲,术中切取供肝重量为360 g,移植物重量受体体重比(GRWR)偏大(5.14%),手术切取供体肝脏左外侧叶,并在体外对供肝进行减体积的肝切除,受体行保留下腔静脉的全肝切除术,然后行供肝原位移植。结果供体手术时间为6小时30分钟,术中出血150 ml,术后1周顺利恢复出院。受体手术时间为8.5小时,无肝期为50分钟;供肝重量为360 g,减体积后为260 g,GRWR降低为3.71%。免疫抑制采用术中甲泼尼龙诱导,术后三联免疫抑制方案(他克莫司+霉酚酸酯+甲泼尼龙)。受者术后25天转氨酶及胆红素指标降至正常,腹部超声提示移植肝血管及血流未见异常,移植肝体积逐月增大。受者腹部伤口Ⅰ级愈合,于术后35天出院。肝移植术后随访6个月,供、受者均未出现任何并发症,受体术后体重迅速增加。结论针对大体积供肝的儿童活体肝移植,采用减体积肝段移植是有效且安全的选择,前提是在术前对供肝血管影像学检查的准确评估以及受者围手术期的严格管理。Objective To report one case of reduced-size liver transplantation in the treatment of children with congenital segment reported cases of biliary atresia. Methods Reduced monosegmental liver transplantation was performed for one patient suffered congenital biliary atresia in our hospital in March 2014. The patient was 5 months old and 7 kg in weight. His mother donated her left lateral liver. Due to graft-to-recipient weight ratio(GRWR)was too high(5.14%),the left lateral donor liver was harvested and further reduced size in vitro. The diseased liver of patient was removed with the vena cava reserved,then orthotopic liver transplantation was performed. Results Donor operative time was 6.5 hours and total amount of bleeding was 150 ml,donor recovered well and discharged 1 week after operation. Recipient operative time was 8.5 hours with 50 minutes of an-hepatic period. Reduced-size graft was 260 g and GRWR was reduced to 3.71%. Intraoperative methylprednisolone induction and triple immunosuppressive regimen(tacrolimus+mycophenolate mofetil+methylprednisolone)were applied for recipient. Recipient condition was well and liver function return to normal level 25 days after operation. Abdominal ultrasound suggest normal hemodynamics and increasing volume of graft liver. Recipient was discharged 35 days after operation and abdominal wound healed with A level. Both donor and recipient were followed up 6 months without any complications. Conclusion To prevent complications associated with large-for-size grafts,further graft reduction could be necessary to overcome the large-for-size graft syndrome,the reduced monosegmental liver transplantation <br> is an safe and effective selection which was based on accurate preoperative radiological assessment of the graft and excellent perioperative care and management to the patient.

关 键 词：儿童 胆管闭锁 减体积 肝段移植 

分 类 号：R726.5[医药卫生—儿科]