活体肝移植几种术式探讨(附50例报告)  

Surgical methods in living donor liver transplantation:with report of 50 cases

作　　者：王学浩[1] 张峰[1] 李相成[1] 李国强[1] 成峰[1] 孙倍成[1] 孔连宝[1] 葛文刚[1] 

机构地区：[1]南京医科大学第一附属医院肝脏移植中心,210029

出　　处：《中华外科杂志》2006年第21期1448-1452,共5页Chinese Journal of Surgery

基　　金：江苏省重点课题资助项目(BJ98025);江苏省医学重点学科建设基金(135-10);江苏省卫生厅课题(455EA9502)

摘　　要：目的探讨活体肝移植不同术式的临床应用。方法对1995年1月至2006年3月我科完成的50例活体肝移植的临床资料进行回顾性分析,探讨活体肝移植不同术式的临床应用和保障供体安全的策略等问题。结果本组资料中,所有供体术后均顺利康复,均未出现严重并发症。适应证:良性终末期肝硬化47例,恶性肿瘤3例。44例受体健在,手术死亡3例,3例死于远期并发症。本组供体右半肝(不包括肝中静脉)9例,右半肝(包括肝中静脉)1例,左半肝(包括肝中静脉)36例,左半肝或左外叶(不包括肝中静脉)4例。结论活体肝移植是解决目前全球供肝短缺问题的重要途径之一。活体肝移植手术过程复杂,根据临床实际选择合理手术方式是保证供体安全和提高手术成功率的关键。Objective To investigate and evaluate different surgical methods applied in living-donor liver transplantation（LDLT）. Methods Fifty patients with end-stage liver disease received LDLT in our department between January 1995 and March 2006. The data were analyzed on a retrospective basis. The choice of different surgical methods, strategies applied to ensure the safety of donors and indications of LDLT in the series were reviewed. Results All donors recovered uneventfully. Among the 50 patients, 47 recipients presented with end-stage cirrhosis, 3 patients suffered from malignant tumor. To date, 6 recipients died after LDLT, among them, 3 recipients died of the operation and the other 3 recipients died of long-term complications. Resected donor livers included 9 cases of segments Ⅴ, Ⅵ, Ⅶ and Ⅷ （ not including the middle hepatic veins） and 1 case of segments Ⅴ, Ⅵ, Ⅶ and Ⅷ （including the middle hepatic veins）, 36 cases of segments Ⅱ , Ⅲ and Ⅳ （including the middle hepatic veins） and 4 cases of segments Ⅱ , Ⅲ, and part of Ⅳ （not including middle hepatic veins）. Conclusions LDLT helps tackle the problem of donor shortage in the world. The process is complicated, and it is very important to choose appropriate surgical methods for the improvement of surgical achievement and donor safety.

关 键 词：肝移植 活体供者 手术方式 

分 类 号：R657.3[医药卫生—外科学]