成人间活体肝移植供体行改良扩大右半肝切除的安全性  

Evaluation of safety of the living donor when donating his right lobe containing the middle hepatic vein

作　　者：陈拥军[1] 彭承宏[1] 沈柏用[1] 詹茜[1] 邓侠兴[1] 杨卫平[1] 陈皓[1] 申川[1] 严佶祺[1] 万亮[1] 李勤裕[1] 祝哲诚[1] 谢俊杰[1] 程东峰[1] 周光文[1] 李宏为[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院外科器官移植中心,上海200025

出　　处：《外科理论与实践》2008年第4期316-321,共6页Journal of Surgery Concepts & Practice

基　　金：上海市科委重点项目(07JC14040)

摘　　要：目的:探讨成人间活体肝移植(A-ALDLT)供体接受带肝中静脉(MHV)的改良扩大右半肝切除术的安全性。方法:2006年6月至2008年1月,23例成人间活体肝移植的供体作了右半肝切除,其中15例为不含MHV的右半肝移植物(第1组,n=15),8例为含MHV的右半肝移植物(第2组,n=8)。选择供体作含MHV的改良扩大右半肝切除术,需满足以下条件:供体残留肝脏>35%,且脂肪肝<10%;移植物不足受体标准肝体积(SLV)的60%;供体MHV右侧有2支以上粗大的V5、V8分支需保留。结果:两组供体在年龄、脂肪肝比例和肝脏残留比例等方面都没有显著差异,手术时间和出血量也没有明显差别。第1组供体的体重和全肝体积要大于第2组,这可能是因为随着我们手术经验的增加,在供体体重小于受体或供肝相对不够大时,会更倾向于使用含MHV的移植物有关。这使得第2组的移植物重量(GW)与第1组的差不多大小,且两组间的GW/SLV、GWRW也无显著差异。而两组供体的术后恢复情况均令人满意,两组残肝的增生比例并没有很大差异。由于第2组术前肝脏体积较小,因此与原肝脏大小比较时,第2组残肝恢复的比例要明显大于第1组。结论:供体行含MHV的改良扩大右半肝切除术,较容易得到更大的移植物,而第4段的少量淤血,可能会增加残肝的增生速度。对于无明显脂肪肝且残留肝脏超过35%的健康供体,切取含MHV的右半肝移植物仍然是安全的。Objective To evaluate the safety of the donor when donating his right lobe of liver containing the middle hepatic vein （MHV） in adult-to-aduh living donor liver transplantation （A-A LDLT）. Methods From June 2006 to January 2008, a total of 23 donors participated in A-A LDLT by donating their right lobe of liver; 15 donors contributed right lobe without MHV （Group 1, n=15） and 8 donated right lobe containing MHV （Group 2, n=8）. The criteria for donation of MHV-included right lobe were as following： the donor possesses 〉35% of the remnant liver volume and steatosis of the donor lobe is less than 10%; donor lobe rolume ≤60% of recipient＇s standard liver volume （SLV）; donor MHV possesses bulky V5 and V8 branches on its right side. Results There was no significant difference between these 2 groups regarding age, steatosis of the graft, remnant liver volume, as well as the operating time and quantity of blood loss. Body weight and whole-liver volume were greater in Group 1 than those in Group 2, and this could be due to our tendency from accumulated surgical experiences to include MHV in the grafts when recipients weight （RW）outweighed donors or when donor livers were relatively small. This strategy aimed at balancing the graft weights （GW）, GW/SLV and GWRW. The donors in both groups recovered satisfactorily, and no major difference in the regeneration of the remnant liver was observed. The recovery of the remnant liver in donors was greater in Group 2 than that in Group 1 when compared with original liver volumes. Conclusions It is more accessible to obtain a larger donor right lobe which contains the MHV. Congestion in segment 4 might help the remnant liver to regenerate. For donors possessing 〉35 % of remmant liver without obvious hepatic steatosis, it is safe for donors to contribute their right lobe with MHV.

关 键 词：肝移植 肝切除术 移植 同种 方法 

分 类 号：R657.3[医药卫生—外科学]