成人活体供者肝右叶联合脑死亡捐献者肝左外叶的双供肝活体肝移植治疗肝细胞癌的应用价值  

Application value of dual-graft living donor liver transplantation of right segment from an adult living donor combined with a left lateral segment from donation after brain death for hepatocellular carcinoma

作　　者：张博瀚 宋九林 蒋利[1] 杨俭[1] 吕涛[1] 黄斌[1] 吴泓[1] 杨家印[1] 严律南[1] Zhang Bohan;Song Jiulin;Jiang Li;Yang Jian;Lyu Tao;Huang Bin;Wu Hong;Yang Jiayin;Yan Lyunan(Department of Liver Surgery,Organ Transplantation Center,West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院肝脏外科器官移植中心,成都610041

出　　处：《中华消化外科杂志》2020年第2期196-203,共8页Chinese Journal of Digestive Surgery

基　　金：十三五国家科技重大专项(2017ZX10203205-005-002);四川大学华西医院学科卓越发展1.3.5工程项目(ZY2017308)。

摘　　要：目的探讨成人活体供者肝右叶联合脑死亡捐献者肝左外叶的双供肝活体肝移植治疗肝细胞癌的应用价值。方法采用回顾性描述性研究方法。收集2019年10月四川大学华西医院收治的1例行成人活体供者肝右叶联合脑死亡捐献者肝左外叶的双供肝活体肝移植受者的临床病理资料;男性肝细胞癌受者,年龄为46岁,体质量为66 kg,身高为171 cm,血型为A型Rh阳性。移植物1来自女性活体供者,年龄为23岁,体质量为50 kg,身高为150 cm,血型为A型Rh阳性。移植物2来自男性脑死亡捐献者,年龄为44岁,血型为A型Rh阳性。手术在3个手术间施行,2个手术间同时施行移植物1和移植物2的切取手术,第3个手术间施行受者肝脏游离,当移植物的体外拼接接近完成时,完整取出受者肝脏,并施行肝移植。观察指标:(1)活体供者及受者的手术及术后恢复情况。(2)受者病肝术后病理学检查情况。(3)随访情况。采用门诊方式进行随访,随访内容包括肝细胞癌复发监测、移植肝功能监测、免疫抑制剂监测调整、胆道血管并发症监测、排斥反应及药物不良反应等。受者需终生定期随访,最近一次随访时间为2019年12月4日。计数资料采用绝对数或百分比表示。结果(1)活体供者及受者的手术及术后恢复情况:活体供者手术时间为315 min,术中出血量约200 mL,术中输入自体回收血量约200 mL,术后第6天出院,无并发症发生。受者顺利完成改良背驼式肝移植。移植物1取自活体供者不含肝中静脉的肝右叶,质量410 g。移植物2取自脑死亡捐献者肝左外叶,质量400 g,拼接后的供者移植物质量与受者体质量比为1.2%。受者手术时间为815 min,无肝期时间为60 min,术中出血量约1500 mL,术中输血量为1800 mL。住院期间受者体温正常。术后第1天受者白细胞(WBC)和中性粒细胞百分比达到峰值(分别为17.15×109/L和91.7%),后逐渐降低,采用哌拉西林钠�Objective To investigate the application value of dual-graft living donor liver transplantation of right segment from an adult living donor combined with a left lateral segment from donation after brain death for hepatocellular carcinoma(HCC).Methods The retrospective and descriptive study was conducted.The clinicopathological data of a male 46-year-old patient with HCC who underwent dual-graft living donor liver transplantation of right segment from an adult living donor combined with a left lateral segment from donation after brain death at the West China Hospital of Sichuan University in October 2019 were collected.He weighed 66 kg and was 171 cm in height.His blood type was A Rh-positive.Graft one was from a female 23-year-old living donor who had a bodyweight of 50 kg,a height of 150 cm,and blood type of A Rh-positive;graft two was from a male 44-year-old brain death donor with the blood type of A Rh-positive.The surgery was performed in three operating rooms,graft one and graft two were obtained simultaneously in two operating rooms,and the recipient′s liver was dissected in the third operating room.When the in vitro splicing of the liver was almost completed,surgeons entirely removed the recipient′s liver and started to transplant the new one.Observation indicators:(1)surgical situations and postoperative recovery of the living donor and the recipient;(2)postoperative pathological examination of the recipient′s liver;(3)follow-up.Follow-up was conducted by outpatient examinations,including monitoring of HCC recurrence,monitoring of new liver function,monitoring and adjustment of immunosuppressive agents,detection of biliary vascular complications,rejection and adverse drug reactions.Regular lifelong follow-up was required for recipients,with the latest follow-up on December 4,2019.Count data were expressed as absolute numbers or percentages.Results(1)Surgical situations and postoperative recovery of the living donor and the recipient:operation time,volume of intraoperative blood loss,volume of intrao

关 键 词：肝肿瘤 成人 超出米兰标准 双供肝 脑死亡供肝 活体肝移植 劈离式肝移植 背驮式肝移植 

分 类 号：R735[医药卫生—肿瘤]