活体肝移植的临床研究  

A clinical study on living donor liver transplantation

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

机构地区：[1]南京医科大学第一附属医院肝移植中心卫生部活体肝脏移植重点实验室,210029

出　　处：《江苏医药》2007年第2期109-113,共5页Jiangsu Medical Journal

基　　金：江苏省医学重点学科建设基金(135-10)

摘　　要：目的总结活体肝移植的临床应用。方法回顾性临床分析75例活体肝移植的临床经验,对活体肝移植的外科技术改进、建立供体安全保障体系和受体预后等问题进行探讨。结果适应证为良性终末期肝病72例,恶性肿瘤3例。75例供体术后顺利康复,均未出现严重并发症;65例(65/75)受体健在,手术死亡5例(5/75),5例死于远期并发症(5/75)。供体右半肝(不包括肝中静脉)21例,扩大右半肝(包括肝中静脉)2例,扩大左半肝(包括肝中静脉)48例,左半肝或左外叶(不包括肝中静脉)4例。术后主要并发症以血管并发症、胆道并发症、细菌及病毒感染和肺部并发症为主。结论活体肝移植具有供肝来源广泛的优点,适合我国国情,有广阔的临床应用前景。改进活体肝移植技术,建立供体安全保障体系是改善受体预后的关键。Objective To evaluate the clinical application of living donor liver transplantation （LDLT）. Methods A retrospective analysis was made in 75 operations of LDLT performed in our hospital The advance of different surgical methods for LDLT, strategy applied to ensure the safety of donors and prognosis of recipients in the series were reviewed. The indication and timing, surgical complications, and nonsurgical issues including infection, rejection, advantages of LDLT in our series were reviewed. Result Seventy-two recipients were end-stage cirrhotic patients, and 3 recipients were the patients with malignant tumor. All donors recovered uneventfully. Ten recipients died after LDLT, Among which, 5 recipients died of operation and the other 5 recipients died of long-term complications. Resected donor livers included 21 cases of segments Ⅴ, Ⅵ,Ⅶ, and Ⅷ （not including the middle hepatic veins） and 2 cases of segments Ⅴ, Ⅵ,Ⅶ, and Ⅷ （including the middle hepatic veins）, 48 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）. The primary complications of blood vessel, biliary tract, lung and the infection of microbe or virus were mainly involved in our aeries. Conclusion LDLT has capacious clinical application with many unsurpassable advantages of plentiful resource and fine quality of graft liver, lower cost of LDLT. To improve the prognosis of recipients, the key points are the improvement of surgical techniques of LDLT and establishment of a system for the safety of donors.

关 键 词：肝移植 活体 成人 

分 类 号：R657[医药卫生—外科学]