活体肝移植治疗终末期肝病  

Living donor liver transplantation for end-stage liver disease

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

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

出　　处：《中华消化外科杂志》2008年第2期89-91,共3页Chinese Journal of Digestive Surgery

基　　金：江苏省重点课题（BJ98025、K200414）;江苏省医学重点学科建设基金（135-10）;江苏省卫生厅课题（455EA9502）;江苏省领军人才基金项目（2006-7）

摘　　要：目的探讨活体肝移植（living donor liver transplantation，LDLT）供、受者术前评估和手术方式的选择。方法回顾性分析1995年1月至2007年10月我中心95例LDLT患者的临床资料。良性终末期肝病92例，其中Wilson病45例；肝脏恶性肿瘤3例。结果供肝切取不带肝中静脉右半肝31例，带肝中静脉右半肝3例，带肝中静脉左半肝51例，不带肝中静脉左半肝或左外叶10例。所有供者术后顺利恢复，均未出现严重并发症。受者随访1～86个月，良性终末期肝病受者1、3、5年累积生存率分别为89％（82例）、78％（71例）和73％（67例），其中Wilson病受者1、3、5年累积生存率分别为92％（42例）、89％（40例）和76％（34例）。3例肝脏恶性肿瘤患者死亡2例，1例长期生存。供、受者铜代谢均恢复正常。结论建立供者安全保障体系是LDLT开展的先决条件，选择合理的手术方式是提高受者生存率的关键。亲体肝移植是治疗Wilson病的有效手段。Objective To investigate preoperative donor and recipient assessment, choice of surgical options in living donor liver transplantation （LDLT）. Methods The clinical data of 95 patients who underwent LDLT from January 1995 to October 2007 in our center were retrospectively analyzed. Of all, 92 recipients were benign end-stage liver disease patients （ including 45 patients with Wilson disease）, and 3 were malignant hepatic carcinoma patients. Results Thirty-one right lobes without middle hepatic vein （MHV）, 3 right lobes with MHV, 51 left lobes with MHV, and 10 left lobes or left lateral lobes without MHV were obtained. All the donors recovered after operation. Recipients with benign end-stage liver disease were followed up for 1 to 86 months, and the 1-, 3-, 5-year accumulative survival rates were 89% （82 cases）, 78% （71 cases） and 73% （67 cases）, respectively. The 1-, 3-, 5-year survival rates of patients with Wilson disease were 92% （42 cases）, 89% （40 cases） and 76% （34 cases）, respectively. For the 3 patients with malignant hepatic carcinoma, 2 died and 1 was alive and well. The copper metabolism was back to normal in both donors and recipients. Conclusions Establishment of a system for the safety of donors is basic for LDLT. The key to raise the recipients＇survival rates is to choose the optimal surgical approach. LDLT is effective in treating Wilson disease.

关 键 词：肝移植 活体 终末期肝病 WILSON病 

分 类 号：R657.3[医药卫生—外科学]