活体供肝肝移植成功的初步经验——附3例报告  

Primary experience in living donor liver transplantation: a report of 3 cases

作　　者：樊嘉[1] 吴志全[1] 郑珊[2] 周俭[1] 邱双健[1] 王玉琦[1] 符伟国[1] 史颖弘[1] 贺轶锋[1] 

机构地区：[1]复旦大学附属中山医院,上海市200032 [2]复旦大学附属儿科医院

出　　处：《中华肝胆外科杂志》2004年第9期586-588,共3页Chinese Journal of Hepatobiliary Surgery

基　　金：上海市科委重大项目 (0 2 41190 0 1)资助

摘　　要：目的　报告 3例活体供肝肝移植成功的初步经验。方法　回顾性分析 1例肝细胞癌伴肝硬化、1例先天性肝内胆汁淤积症及 1例药物性肝炎病人活体供肝肝移植经过和供受体恢复情况。结果　供肝均取自病人父亲 ,1例为右半肝 ,另 2例为扩大左外叶 ,供肝重量分别为 835g、2 95g及 32 0g。第 1例供体术后有一过性黄疸 ,且有轻度胆漏 ,另 2例供体术后恢复顺利 ,无手术并发症。 3例病人手术均顺利 ,1例成人 成人活体供肝肝移植胆道重建为胆管端端吻合 ,术后定期行全身化疗预防肿瘤复发。 2例成人 儿童活体供肝肝移植胆道重建为胆管、空肠Roux en Y吻合。 3例病人均行肝静脉整形以保证静脉回流通畅。随访至今 ,供受体已分别健康生存 16、14、13个月。结论　严格的病例选择 ,完善的术前准备 ,精细的手术操作及正确的术后处理是活体供肝肝移植成功的关键。Objective To review the primary experience in living donor liver transplantation (LDLT) in 3 cases. Methods Three cases receiving LDLT for hepatocellular carcinoma (HCC) with severe cirrhosis, congenital intrahepatic cholestasis and drug-related hepatitis, respectively, were retrospectively analyzed and the outcomes of donors and recipients reviewed. Results The grafts all came from the patients' fathers. The graft type was right lobe in the first case extended left lateral segment in other 2. The graft weight was 835 g, 295 g and 320 g in the 3 cases, respectively. The donor for the first case suffered from temporarily postoperative jaundice and mild bile leakage and the other 2 donors and all recipients successfully recovered. The biliary reconstruction was performed with duct-to-duct anastomosis in one case of adult-to-adult LDLT but standard Roux-en-Y anastomosis in other 2 cases. The recipients with HCC received regular systemic chemotherapy to prevent tumor recurrence. All the 3 recipients underwent hepatic vein reconstruction to facilitate venous drainage. The followed-up study till now showed that the recipients and donors have survived for 16, 14 and 13 months in good health, respectively. Conclusions Strict selection of indications, perfect preoperative preparation, subtle operative manipulation and proper postoperative management are important for successful LDLT.

关 键 词：活体供肝 肝移植 并发症 右叶供肝 

分 类 号：R657.3[医药卫生—外科学]