成人亲属间活体肝移植获得成功2例报告  

Adult-to-adult living-related donor liver transplantation: report of 2 cases

作　　者：杨定华[1] 周杰[1] 李湘竑[1] 林建华[1] 刘延[1] 王宇[1] 张国伟[1] 崔忠林[1] 谭永法[1] 林艺雄[1] 张启帆[1] 阚和平[1] 廖彩仙[1] 方学军[1] 

机构地区：[1]南方医科大学南方医院肝胆外科,广东广州510515

出　　处：《南方医科大学学报》2011年第12期2061-2066,共6页Journal of Southern Medical University

基　　金：广州市白云区科技攻关项目(2010-KZ-36)

摘　　要：目的总结和分析成人间活体右半肝肝移植的可行性及安全性。方法对2010年7月6日和2010年11月30日2例成人间活体肝移植的临床资料进行回顾性分析。结果供体为右半肝带肝中静脉1例,右半肝不带肝中静脉1例,GV/SLV分别为46.2%和47.3%;GR/WR分别为0.83和0.80。RLR分别为42.1%和39.5%。供体手术历时分别为6.5 h和5 h,失血约200 ml和250 ml,供者术后第7天肝功能恢复正常,无并发症,分别于术后第14天和16天出院。2例受者手术历时分别为8 h和7 h,失血800 ml和1000 ml,供肝的肝静脉与受体的右肝静脉、门静脉右支-门静脉右支、右肝管-右肝管,以及右肝动脉-右肝动脉行端端吻合。第1例受者术后2个月出现胆管吻合口狭窄,经PTCD治疗好转,第2例受者无任何并发症发生。出院后随访至今,供受体恢复均良好,肝功能正常。结论成人亲属间活体肝移植是在尸体供肝短缺的情况下治疗终末期肝病的安全有效的手段。Objective To investigate the feasibility and safety of adult-to-adult living-related donor liver transplantation using a right lobe graft.Methods The clinical data of 2 cases of living-related donor liver transplantation performed between July,2010 and November,2010 were analyzed.Results Liver transplantation was performed using a right lobe graft including the middle hepatic vein in one case and a right lobe graft without the middle hepatic vein in the other.The ratio of graft volume to standard liver volume was 46.2% and 47.3% in the two cases,with GR/WR of 0.83 and 0.80,and donor residue liver of 42.1% and 39.5%,respectively.The donor operation lasted for 6.5 h and 5 h in the two cases with blood loss of about 200-250 ml without blood transfusion.The donors recovered uneventfully without any surgical complications,whose liver function was normal 7 days after the operation,and were discharged 14 days and 16 days after the surgery,respectively.The recipient operation lasted for 8 h and 7 h with blood loss of about 800-1000 ml.The right hepatic vein,hepatic artery,portal vein and bile duct reconstruction were performed by end-to-end anastomoses in the 2 recipients.Bile duct anastomosis stricture occurred in the first recipient 2 months after transplantation and was treated with percutaneous transhepatic cholangiography and drainage.The second recipient recovered smoothly without any complications.The recipients have so far survived 9 months and 5 months,respectively.Conclusion Adult-to-adult living-related donor liver transplantation is a safe and effective option for treatment of end-stage liver diseases in the context of cadaveric liver graft shortage.

关 键 词：成人 右半肝 活体 肝移植 

分 类 号：R657.3[医药卫生—外科学]