原位肝移植供肝撕裂伤的处理  

Management of graft laceration in orthotopic liver transplantation

作　　者：汤睿[1] 吴广东 杨威[1] 童翾 王开宇[1] 于里涵 李昂[1] 卢倩 TANG Rui;WU Guang-dong;YANG Wei;TONG Xuan;WANG Kai-yu;YU Li-han;LI Ang;LU Qian(Hepatopancreatobiliary Center,Beijing Tsinghua Changgung Hospital,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院肝胆胰中心,北京102218

出　　处：《肝胆胰外科杂志》2021年第6期321-324,共4页Journal of Hepatopancreatobiliary Surgery

基　　金：国家科技重大专项(2017ZX100203205);国家自然科学基金项目(81930119);北京清华长庚医院研究基金(12019C1012)。

摘　　要：目的探讨原位肝移植供肝获取过程中发生撕裂伤的处理方式。方法对2018年2月至2021年1月清华大学附属北京清华长庚医院297例原位肝移植手术中供肝撕裂伤的情况进行回顾性分析。对供肝撕裂伤进行分级分度:包膜撕裂<2 cm为A级,≥2 cm但<5 cm为B级,≥5 cm为C级;无明显肝实质裂伤即肝实裂深度<1 mm为I°,≥1 mm但<5 mm为II°,≥5 mm为III°。根据供肝撕裂伤分级分度情况分析处理方式及手术效果。结果297例中共发生供肝撕裂伤31例(10.4%)。心脏死亡供者供肝损伤率明显高于脑死亡供者[14.7%(19/129)vs 7.1%(12/168),P<0.05]。损伤位于右肝的情况明显多于左肝(26例vs 5例,P<0.05)。撕裂伤程度A级15例,B级12例,C级4例;I°18例,II°10例,III°3例。裂伤U型缝合14例,包膜贴敷+U型缝合8例,包膜敷贴可以有效降低C级或III°创伤出血量。结论基于撕裂伤分级分度选择肝脏U型缝合或包膜贴敷+U型缝合可以有效处理原位肝移植供肝获取中造成的肝脏撕裂伤,降低术中出血风险。Objective To investigate the management of graft laceration during organ procurement in orthotopic liver transplantation(OLT).Methods The incidence of liver laceration in 297 patients who received OLT from Feb.2018 to Jan.2021 in Beijing Tsinghua Changgung Hospital was analyzed retrospectively.Classification and degree of liver laceration were set as capsule tear area:<2 cm was level A,≥2 cm but<5 cm was level B,≥5 cm was level C.No obvious liver parenchymal laceration(depth<1 mm)was grade I°,depth≥1 mm but<5 mm was grade II°,and≥5 mm was grade III°.Damage control and surgical results were recorded.Results Among 297 patients,31 cases(10.4%)had donor liver laceration.The graft liver injury rate of cardiac death donor was significantly higher than that of brain death donor[14.7%(19/129)vs 7.1%(12/168),P<0.05].More injury occurred in the right liver than in the left(26 cases vs 5 cases,P<0.05).The degree of laceration was 15 cases in level A,12 cases in level B,and 4 cases in level C.There were 18 cases with grade I°laceration,10 cases with grade II°laceration,and 3 cases with grade III°laceration.U-shape suture was used in 14 cases of lacerations,and capsular application+U-shape suture was used in 8 cases.Capsular application effectively reduced the bleeding of level C or grade III°graft laceration.Conclusion Based on level and grade of injury,U-shape suture or capsular application+U-shape suture can effectively treat liver lacerations caused by donor liver procurement surgery in OLT and can reduce the risk of intraoperative bleeding.

关 键 词：原位肝移植 供肝获取 肝撕裂伤 损伤控制 供肝修整 

分 类 号：R657.3[医药卫生—外科学]