劈离式多米诺供肝辅助性肝移植的临床价值  

Clinical value of split domino donor auxiliary liver transplantation

作　　者：张文杰 徐庆祥[1] 李国强 余德才[1] 岳杨 朱新华[1] 刘巧玉 崔恒[1] 孙倍成 Zhang Wenjie;Xu Qingxiang;Li Guoqiang;Yu Decai;Yue Yang;Zhu Xinhua;Liu Qiaoyu;Cui Heng;Sun Beicheng(Department of Hepatobiliary and Pancreatic Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院肝胆胰中心,南京210008

出　　处：《中华消化外科杂志》2022年第2期287-294,共8页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(81930086, 82171737);国际(地区)合作与交流项目(82120108012);国家重点研发计划精准医学重点专项(2016YFC0905900);南京鼓楼医院临床研究专项资金(2021-LCYJ-PY-28)。

摘　　要：目的探讨劈离式多米诺供肝辅助性肝移植的临床价值。方法采用回顾性描述性研究方法。收集南京大学医学院附属鼓楼医院2018年9月收治的3例、外院收治的1例肝移植受者的临床病理资料。病例1,男,22岁,诊断为Ⅱ型瓜氨酸血症(CTLN2);病例2(外院收治),男,59岁,诊断为酒精性肝硬化失代偿期;病例3,女,52岁,诊断为肝右叶肝细胞癌;病例4,女,51岁,诊断为肝右叶肝细胞癌。1例脑-心死亡供器官肝脏获取后离体劈离分成左半肝和右半肝(不含肝中静脉),分别行改良背驼式肝移植和经典原位肝移植植入病例1和病例2。病例1的肝脏在体原位劈离为左半肝和右半肝。病例3和病例4均行扩大右半肝切除术后。病例3将病例1的左半肝行背驼式辅助肝移植,病例4将病例1右半肝行背驼式辅助肝移植。观察指标:(1)术中情况。(2)随访情况。采用门诊和电话方式进行随访,了解受者肝功能、肝脏影像学检查表现、并发症、生存情况。随访时间截至2021年10月。结果(1)术中情况:病例1、病例3、病例4均顺利完成手术,手术时间分别为400、370、390 min,术中出血量分别为600、1300、1600 mL,供肝冷缺血时间分别为230、152、135 min,移植物受者体重比率为1.2%、0.8%、1.1%。(2)随访情况:3例受者肝移植术后经B超检查均提示血流正常且痊愈出院,均获得术后1、6、12个月随访。病例1、病例3、病例4肝移植后1周肝功能良好且血氨、瓜氨酸浓度正常。病例1和病例3术后肝脏影像学检查均正常,病例4肝脏影像学检查结果示门静脉盗血致移植肝萎缩。①病例1肝移植术前、术后1 d、术后2 d、术后3 d、术后7 d、术后10 d、术后6个月、术后1年丙氨酸氨基转移酶(ALT)分别为22.8、404.1、355.5、289.6、31.0、23.1、42.1、25.8 U/L,天冬氨酸氨基转移酶(AST)分别为31.5、517.7、327.6、172.9、15.9、21.4、47.5、29.7 U/L,总胆红素(TBil)分别为3.8、Objective To investigate the clinical value of split domino donor auxiliary liver transplantation.Methods The retrospective and descriptive study was conducted.The clinco-pathological data of 3 liver transplantation recipients who were admitted to Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School and 1 liver transplantation recipient who was admitted to external hospital in September 2018 were collected.The first case was male,aged 22 years,who was diagnosed as type II citrullinemia(CTLN2).The second case undergoing liver transplantation in external hospital was male,aged 59 years,who was diagnosed as decompensated alcoholic cirrhosis.The third case was female,aged 52 years,who was diagnosed as hepatocellular carcinoma of right lobe of liver.The fourth case was female,aged 51 years,who was diagnosed as hepatocellular carcinoma of right lobe of liver.The donor liver from a brain and cardiac death donor was split in vitro into the left liver and the right liver,in which the right liver without middle hepatic vein,and the modified piggyback liver transplantation using the left liver and the classical orthotropic liver transplantation using the right liver was conducted on the first and the second case,respectively.The original liver of the first case was split in vivo into the left liver and the right liver,and the piggyback auxiliary liver transplantation using the left liver and the piggyback auxiliary liver transplantation using the right liver was conducted on the third and the fourth case who underwent extended right hemihepatectomy,respectively.Observation indicators:(1)intraoperative situations;(2)follow-up.Follow-up was conducted using outpatient examination and telephone interview to detect liver function,liver imaging,complication and survival of recipients up to October 2021.Results(1)Intraoperative situations.Liver transplantation was conducted successfully on the first,third and fourth case,with the operation time,the volume of intraoperative blood loss,the donor liver cold isc

关 键 词：肝肿瘤 成人瓜氨酸血症Ⅱ型 多米诺肝移植 劈离肝移植 辅助肝移植 临床应用 

分 类 号：R657.3[医药卫生—外科学]