肝肾联合供体快速切取失误及其防范  

Prevention and accident injury in the process of combined liver and kidney graft rapid harvesting

作　　者：傅斌生[1,2] 张彤[1,2] 李华[1,2] 易述红[1,2] 汪根树[1,2] 张剑[1,2] 姜楠[1,2] 许赤[1,2] 杨扬[1,2] 陆敏强[1,2] 陈规划[1,2] 

机构地区：[1]中山大学附属第三医院肝移植中心 [2]中山大学器官移植研究所广东省器官移植研究中心,广东广州510630

出　　处：《中国实用外科杂志》2011年第10期947-949,共3页Chinese Journal of Practical Surgery

基　　金：国家重点基础研究发展计划(973计划)课题(2009CB522404);国家十一五科技重大专项课题(2008ZX10002-025);广东省科技计划项目重大专项(2007A032000001);教育部新教师基金(20100171120084,20100171120087)

摘　　要：目的探讨快速肝肾联合供体切取过程中的失误并总结经验。方法回顾性分析中山大学附属第三医院肝移植中心2008年1月至2009年6月共232例肝肾联合快速切取过程中的失误和肝动脉变异以及损伤情况。快速切取技术采用原位腹主动脉-肠系膜上静脉灌注加下腔静脉引流,肝肾整块切取后分离肝肾。结果肝脏包膜不同程度撕裂伤25例(10.8%),肝脏左叶刀割伤1例。1例重度脂肪肝植入后原发性无功能。肾脏损伤2例,1例为右肾实质切割伤,1例肾窦处肾静脉撕裂伤,无法修整均废弃。肝肾分离时高位离断第一肝门1例。肝动脉变异46例(19.8%),76%(35/46)的变异动脉起自胃左动脉和肠系膜上动脉。变异肝动脉损伤3例(6.5%),2例起自胃左动脉的副肝左动脉,1例起自肠系膜上动脉的副肝右动脉。结论肝肾联合快速切取技术能同时保护肝肾供体的质量,其方法简单、安全。充分的灌注、娴熟的切取技巧以及防止变异肝动脉的损伤是保证供体质量的关键。Objective To evaluate accident injury in the process of combined liver and kidney graft rapid harvesting and summarize clinical experiences. Methods From January 2008 to June 2009, a quick procedure for combined liver and kidney procurement was used in 232 cases. The clinical data of the cases, including accident injury of graft and anomalous hepatic arteries were analyzed retrospectively. The procedure included in situ perfusion through aorta and superior mesenteric vein plus drainage through inferior vena cava. Liver and kidney were separated after harvested en bloc. Results Varied degree laceration of liver capsule existed in 25 cases （10.8%）, and knife wound in left lobe of liver in 1 case. Primary non-function was found after implanted the severe fatty liver graft in I case. Kidney injury existed in 2 cases including 1 case of cuts in renal parenchyma of the right kidney and 1 cases of renal vein,laceration in renal sinus, which were discarded because they could not be repaired. The first hepatic portal was cut at the high level during separation in 1 case. Anomalous hepatic arteries were found in 46 grafts （19.8%） with 76 percents of anomalous arteries originating from the left gastric artery and the superior mesenteric artery. Accident injury of anomalous hepatic artery was： found in 3 cases （6.5%）, including the left hepatic artery originating from the left gastric artery （2 cases）and the right hepatic artery originating from the superior mesenteric artery （1 case）. Conclusion Combined !iver and kidney graft rapid harvesting is a simple and safe procedure, which can protect the quality of liver and kidney simultaneously. Adequate perfusion, skilled procurement techniques and the prevention of anomalous hepaticarteries injury are critical to assurance of graft quality.

关 键 词：肝移植 供体 肝动脉变异 

分 类 号：R6[医药卫生—外科学]