劈离式肝移植的临床应用  

Clinical application of splitting liver transplantation

作　　者：陈新国[1] 李威[1] 吴风东[1] 邹卫龙[1] 刘煜[1] 王毅[1] 臧运金[1] 朱晓丹[1] 关兆杰[1] 范宁[1] 岳扬[1] 沈中阳[1] 

机构地区：[1]武警总医院器官移植研究所,北京100039

出　　处：《中华肝脏外科手术学电子杂志》2014年第3期9-12,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家高技术研究发展计划(863计划)项目(2012AA021006)

摘　　要：目的探讨劈离式肝移植（SLT）的安全性及疗效。方法回顾性研究2008年1月至2013年8月在武警总医院器官移植研究所行SLT的10例供者和19例受者临床资料。受者中男9例，女10例；年龄7个月～62岁，中位年龄31岁；儿童9例，成人10例；移植物重量与受体体重比（GRWR）为1.0%～4.3%。所有患者均签署知情同意书，符合医学伦理学规定。10例尸体供肝均采用体外劈离的方法。9例供肝劈离后分别移植给9例儿童和8例成人，肝左外叶（Ⅱ、Ⅲ段）移植给儿童受者，扩大右半肝（Ⅰ、Ⅳ～Ⅷ段）移植给成人受者；另1例供肝实施左、右半肝劈离，移植给2例成人。接受肝左外叶移植的9例儿童及1例接受右半肝的成人受者行背驮式肝移植术，接受扩大右半肝移植的8例成人及接受左半肝移植的1例成人受者行经典原位肝移植术。观察受者围手术期死亡及并发症发生情况，出院后受者接受定期随访，观察存活情况。结果19例受者均顺利完成手术，17例痊愈出院，围手术期死亡2例。2例死亡受者均为儿童，其中1例术后2周死于感染性休克，另1例再次肝移植术后2d死于原发性移植肝无功能。2例儿童受者发生肝断面胆漏，行穿刺引流后治愈。1例胆管细胞型肝癌成人受者术后15个月死于肺、骨多发转移。结论 SLT是一种安全、可行的肝移植术式，在一定程度上可缓解供肝短缺的问题。Objective To investigate the safety and efficacy of splitting liver transplantation （SLT）. Methods Clinical data of 10 donors and 19 recipients undergoing SLT in Institute of Organ Transplantation, General Hospital of Chinese People＆#39;s Armed Police Forces from January 2008 to August 2013 were analyzed retrospectively. Of these 19 recipients, 9 were male, 10 were female and 9 were children,10 were adults. The age ranged from 7 months to 62 years with a median age of 31 years. The graft recipient weigh ratio （GRWR） was 1.0%to 4.3%. The informed consents of all patients were obtained and the ethical committee approval was received. The 10 cadaveric donor livers were split in vitro, in which 9 pair grafts were transplanted in 9 children and 8 adults respectively. The left lateral lobes （segmentⅡ,Ⅲ） were transplanted in children and the extended right lobes （segmentⅠ,Ⅳ-Ⅷ） in adults. The other donor liver was split in left and right half lobes and were transplanted in 2 adults. Piggyback liver transplantation was performed in the 9 children receiving left lateral lobes and 1 adult receiving right half lobe. Classic orthotopic liver transplantation was performed in the 8 adults receiving extended right lobes and 1 adult receiving left half lobe. Peri-operative death and complications of the patients were observed. The patients were followed up regularly for observing the survival situation. Results All the operations of 19 recipients were completed successfully. Seventeen cases were cured and discharged from hospital and 2 cases died during the peri-operative period. The 2 dead cases were both children. One died of septic shock 2 weeks after operation and the other died of primary liver graft nonfunction 2 d after liver retransplantation. Biliary leak of liver section occurred in 2 pediatric recipients and was cured by puncture drainage. One adult recipient with intrahepatic cholangiocarcinoma died of lung and bone multiple metastases 15 months after operation. Conclusions SLT is a safe a

关 键 词：肝移植 劈离式 术后并发症 

分 类 号：R657.3[医药卫生—外科学]