28例婴儿活体肝移植的临床分析  

Clinical study of 28 patients with adult-to-infant living donor liver transplantation

作　　者：张明满[1] 严律南[2] 蒲从伦[1] 李英存[1] 康权[1] 郭春宝[1] 戴小科[1] 任志美[1] 邓玉华[1] 

机构地区：[1]重庆医科大学附属儿童医院外科,400014 [2]四川大学华西医院肝移植中心

出　　处：《中华肝脏病杂志》2010年第10期754-757,共4页Chinese Journal of Hepatology

基　　金：基金项目：十一五国家科技支撑计划课题（2006BAI05A06）

摘　　要：目的 总结成人活体供肝婴儿肝移植临床经验,分析术后疗效、并发症及其原因.方法 回顾性分析我院28例成人活体供肝婴儿活体肝移植供、受者临床资料,手术策略、术后治疗和并发症发生情况及其原因.婴儿受者男性和女性各14例,均为胆道闭锁伴胆汁性肝硬化失代偿患者.移植时年龄80d～11.5个月、体质量3.08～10.3 kg;供者分别为：母亲15例,父亲9例、祖母3例和堂兄1例;供肝为：左外叶肝脏27例、Ⅱ段肝脏1例.随访时间5～24个月.结果 术后供者均顺利出院、无并发症发生;20例（71.4%）受者术后出现24个并发症,包括：肝动脉血栓形成4例,肝静脉狭窄1例,腹腔出血4例,肠穿孔4例,肠梗阻2例,呼吸道感染7例,排异反应3例等.围手术期因肝动脉血栓形成死亡3例（10.7%）,手术成功率为89.3%.随访期内1例因肝静脉狭窄死亡,另1例因意外食物窒息死亡,其余23例（82.1%）健康生活至本研究结束.结论 成人活体供肝婴儿肝移植是治疗婴儿终末期肝病的有效方法,血管并发症是术后婴儿受者死亡的主要原因.Objective To summarize our experience in adult-to-infant living donor liver transplantation （A-ILDLT） and to analyze the efficacy and complications of A-ILDLT. Methods The clinical data, surgical strategies and complications of 28 adult donors and infantile recipients who underwent A-ILDLT from April 2006 to December 2009 were retrospectively analyzed. These 28 patients （14 boys and 14 girls） aged from 80 days to 11.5 months with body weights of 3.08 to 10.3 kg at the time of operation. They suffered from biliary atresia with decompensated cirrhosis. The living donors were 15 mothers, 9 fathers, 3 grandma and 1 elder brother with ABO compatible with the infantile recipients. 27 Donor organs were the left lateral lobe grafts （segment Ⅱ, Ⅲ） and 1 graft was segment Ⅱ. All patients were followed up for 5 to 24 months. Results These grafts were orthotopically transplanted into the infantile recipients. The average length of stay was 9.3 days for the donor group without any complications. Postoperative immunosuppression included prednisone,Cyclosporin and mycophenolate mofetil （MMF）. A total of 24 postoperative complications occurred in 20 recipients, including 5 vascular complications, 4 bleeding, 7 pneumonia, 2 bowel obstruction, 4 intestinal perforation and 3 rejection. Three recipients died of hepatic arterial thrombosis （HAT）. The perioperative mortality rate of recipients was 10.7% （3/28） and the survival rate was 89.3% in peroperative period. One died of stricture of hepatic vein and 1 of accidental asphyxia during follow-up term. At present, 23 cases are still alive. Conclusion A-ILDLT has become an effective method to infants with end-stage liver disease. The postoperative vascular complication is the predominant cause of death.

关 键 词：肝移植 活体供者 婴儿 胆道闭锁 

分 类 号：R686[医药卫生—骨科学]