150例活体肝移植供肝的后台修整  

The backtable procedures for living donor liver graft

作　　者：淮明生[1] 朱志军[1] 郑虹[1] 邓永林[1] 潘澄[1] 蒋文涛[1] 张雅敏[1] 蔡金贞[1] 沈中阳[1] 

机构地区：[1]天津第一中心医院移植外科,300192

出　　处：《中华普通外科杂志》2010年第2期92-94,共3页Chinese Journal of General Surgery

基　　金：天津市科委重点项目基金资助（08ZCZDSF03100）;China Medical Boardin New York基金资助（06837）

摘　　要：目的总结150例活体供肝的后台修整经验。方法回顾性分析2007年2月至2008年5月间完成的150例活体供肝的修整资料。结果150例供肝中，包含肝中静脉及尾状叶的左半肝3例，肝左静脉与肝中静脉成形；左外侧叶2例；带肝中静脉右半肝67例，肝右静脉与肝中静脉成形；不带肝中静脉右半肝78例。78例不带肝中静脉右半肝中23例未进行S5、S8静脉的重建，供肝血流恢复后S5、S8肝组织均有不同程度的淤血。其余55例用不同材料重建S5、S8静脉：新鲜尸体髂静51例，受体大隐静脉1例，受体曲张脐静脉1例，受体肝内门静脉1例，受体肝静脉1例。145例右半肝供肝中门静脉为C型的7例，均成形为一个开口。结论HTK是活体供肝的最佳灌注、保存液，供肝流出道恰当的成形、重建不但可简化供肝植入的操作步骤，还可最大限度的保护有功能的肝组织，是受体术后顺利恢复的关键。Objective To summarize the experience of backtable procedures for living donor liver graft in 150 eases. Methods We reviewed data on 150 cases of living donor graft＇s procedure in baektable. Results A total of 150 grafts were harvested. Graft type includes： Left liver graft （including caudate and the middle hepatic vein ） in 3 cases, the left hepatic vein and middle hepatic vein were incorporated into a single orifice. Left lateral lobe in 2 cases. Right liver graft with the middle hepatic vein in 67 cases, incorporating the right hepatic vein and middle hepatic vein into a single orifice. Right liver graft without the middle hepatic vein in 78 cases. Among those, 23 graft＇s S5、S8 veins were closed and all the cases presented venous congestion of S5、S8 after portal vein reperfusion. In the other 55 grafts, S5、S8 hepatic veins were reconstructed with different materials, including cold-storage cadaverie iliac veins used in 51 case, great saphenous vein, varicose umbililical vein, recipient intrahepatic portal vein and recipient intrahepatie vein one each used in the remaining 4 cases. Among the 145 right grafts, type-C portal vein was identified in 7 cases and venoplasty was performed to incorporate 2 portal veins into a single orifice. Conclusions HTK is the best preservation solution for living donor graft. Donor graft outflow venoplasty and reconstruction can simplify implanted procedure and it is important for postoperative recovering of the recipients.

关 键 词：肝移植 活体供者 静脉成形 

分 类 号：R657.3[医药卫生—外科学]