肝移植初期连续成功10例报告  

Piggyback Orthotopic Liver Transplantation: A Report of 10 Successfully Performed Consecutive Cases

作　　者：彭淑牖[1] 彭承宏[1] 吴育连[1] 徐培华[1] 周凡[1] 沈宏伟[1] 徐斌[1] 江献川[1] 刘颖斌[1] 范明敏[1] 徐世伟[1] 

机构地区：[1]浙江大学医学院附属第二医院,310009

出　　处：《外科理论与实践》2002年第2期134-138,共5页Journal of Surgery Concepts & Practice

摘　　要：目的：总结开展肝移植最初阶段连续１０例背驮式肝移植（ＰＯＬＴ）的经验。方法：１９９９年８月３１日～２００１年２月９日，连续进行了肝移植１０例。全部均使用彭氏多功能手术解剖器（ＰＭＯＤ）施行，１０例中２例为Ｃａｒｏｌｉ病；３例为肝细胞性肝癌；一例为肝糖元累积症Ⅰ型伴多发性肝腺瘤；一例为硬化性胆管炎；一例为原发性胆汁性肝硬化；２例为终末期肝硬化。除一例行静脉转流辅助外，余９例均未行转流。供肝的流出道均采用受体的肝中肝左静脉共干与供肝的肝上下腔静脉行端端吻合。胆道重建除一例行胆管空肠Ｒｏｕｘ－Ｙ吻合外，其余９例均为胆道端端吻合并于吻合口远端置Ｔ字管，其近端超过吻合口，作支撑管之用。结果：除一例于术后８月死亡外，其余全部存活，首例至今近２年半。一年成活率９０％（９／１０）。其中第２例于术后２月就恢复工作至今。结论：进行肝移植的动物实验是临床肝移植前非常必要的训练过程。应用ＰＭＯＤ刮吸解剖法十分有助于ＰＯＬＴ的开展。围手术期的监护、相应治疗以及术后严密随访是成功的保障。Objective:To summarize the experiences in piggyback orthotopic liver transplantation (POLT) in 10 successfully performed consecutive cases. Methods: On 31 August 1999, the first case of orthotopic liver transplantation(OLT) was carried out in this hospital, there after another 9 cases were performed with success. During the operations, Peng＇s Multifunctional Operative Dissector(PMOD) lent great help to the execution of the acts of curettage and aspiration. POLT was used in all the 10 cases (2 cases of Carol＇s disease, 3 hepatocellular carcinoma(HCC), 1 glycogen storage syndrome, 1 sclerosing cholangitis, 1 primary biliary liver cirrhosis, 2 end-stage liver cirrhosis). Venous bypass was only applied in one case. The suprahepatic inferior vena cava(IVC) of the homograft was anastomosed end-to-end to the common trunk of middle and left hepatic vein in all the cases. End-to-end billiary duct anastomosis was carried out for reconstruction with a T tube to be retained for few months as a stent in 9 cases, and by Roux-Y hepato-jejunostomy in 1 cases. Results:One case who died in 8 months after the operation, while the other 9 cases are surviving well, the second case resumed his job as a sales manager 2 months after the operation and is still doing well almost 2.5 years post-operatively. Conclusions:POLT can be employed for the majority of OLT candidates. The technique of curettage and aspiration by aid of PMOD is very helpful in carrying out the POLT. While starting a liver transplantation program, it is advisable to conduct first animal experimentation for the training of a good team. Perioperative monitoring and management are vital and follow-up studies are important as well.

关 键 词：背驮式肝镖成尖率 刮吸解剖法 多功能手术解剖器 肝移植 

分 类 号：R657.3[医药卫生—外科学]