劈离式肝移植右侧供肝肝内胆管的解剖分型与胆道重建  

Anatomic classification and reconstruction of right intrahepatic bile duct in the donor liver of split liver trans-plantation

作　　者：韦金铭 傅斌生[1] 杨卿[1] 张彤[1] 冯啸[1] 曾凯宁[1] 姚嘉[1] 唐晖[1] 陈规划[1] 杨扬[1] 易述红[1] Wei Jinming;Fu Binsheng;Yang Qing;Zhang Tong;Feng Xiao;Zeng Kaining;Yao Jia;Tang Hui;Chen Guihua;Yang Yang;Yi Shuhong(Department of Hepatic Surgery,Liver Transplantation Center,the Third Affiliated Hospital of Sun Yat‑sen University,Guangzhou 510600,China)

机构地区：[1]中山大学附属第三医院肝脏外科暨肝移植中心,广州510600

出　　处：《中华消化外科杂志》2024年第2期272-279,共8页Chinese Journal of Digestive Surgery

基　　金：广东省科技计划项目(20169013);广州地区临床高新、重大和特色技术项目(2023P⁃GX05)。

摘　　要：目的探讨劈离式肝移植(SLT)右侧供肝肝内胆管的解剖分型与胆道重建。方法采用回顾性描述性研究方法。收集2014年7月至2022年1月中山大学附属第三医院收治的85例行SLT患者的临床资料;男65例,女20例;年龄为45(1~82)岁。观察指标:(1)手术情况。(2)右侧供肝肝内胆管解剖情况。(3)胆道重建情况。(4)术后胆道并发症情况。(5)随访情况。正态分布的计量资料以x±s表示;偏态分布的计量资料以M(范围)或M(Q1,Q3)表示。计数资料以绝对数或百分比表示,组间比较采用χ2检验或Fisher确切概率法。结果(1)手术情况。85例供肝中,采用左右半肝劈离方式11例,采用经典的右三叶和左外叶劈离方式74例。85例供肝冷缺血时间为291(273,354)min;受者手术时间为(497±97)min,无肝期时间为51(40,80)min,输血量为8(7,12)U。(2)右侧供肝肝内胆管解剖情况。85例供肝中,经典胆管解剖模型(1型)47例,占比为55.3%(47/85),解剖变异型38例,占比为44.7%(38/85)。38例解剖变异型分别为:2型7例,3a型16例,3b型2例,3c型2例,4型1例,5a型3例,5b型4例,6型3例。85例供肝的胆管劈离方式中,84例为保留肝总管主干于右半肝或右三叶,1例行完全左右半肝劈离将肝总管主干保留于左半肝,右半肝保留右肝管(1型);84例仅有1个胆管开口,1例有2个胆管开口(3c型)。(3)胆道重建情况。85例受者胆道重建方案为供肝胆总管-受者胆总管端端吻合69例(1型38例、2型5例、3a型14例、3b型2例、4型1例、5a型3例、5b型4例、6型2例),供肝胆总管-受者空肠吻合11例(1型7例、2型2例、3c型1例、6型1例),供肝肝总管-受者空肠吻合3例(1型1例、3a型2例),供肝右肝管-受者空肠吻合1例(1型),供肝右后支-受者肝总管端端吻合+供肝肝总管-受者空肠Roux-en-Y吻合1例(3c型)。(4)术后胆道并发症情况。85例受者中,6例发生胆道并发症,发生率为7.1%(6/85)。6例发生胆道并发症受者中,5例为1型,1�Objective To investigate the anatomic classification and reconstruction of right intrahepatic bile duct in the donor liver of split liver transplantation(SLT).Methods The retrospective and descriptive study was constructed.The clinical data of 85 patients who underwent SLT in the Third Affiliated Hospital of Sun Yat‑sen University from July 2014 to January 2022 were collected.There were 65 males and 20 females,aged 45(range,1−82)years.Observation indicators:(1)surgical conditions;(2)anatomy of right intrahepatic bile duct;(3)bile duct reconstruction;(4)postoperative biliary complications;(5)follow‑up.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(range)or M(Q1,Q3).Count data were described as absolute numbers or percentages,and comparison between groups was conducted using the chi‑square test or Fisher exact probability.Results(1)Surgical conditions.Of the 85 donor livers,11 donor livers were split between the left and right hemilivers,and 74 donor livers were split between the classic right trilobe and left lateral lobe.The cold ischemia time of 85 donor livers was 291(273,354)minutes,and the operation time,anhepatic phase time and volume of intraoperative blood transfusion of 85 recipients were(497±97)minutes,51(40,80)minutes and 8(7,12)U.(2)Anatomy of right intrahepatic bile duct.Of the 85 donor livers,there were 47 donor livers with classic bile duct anatomical model(type 1),of the ratio as 55.3%(47/85),and 38 donor livers with anatomical variants,of the ratio as 44.7%(38/85).Of the 38 donor livers with anatomical variants,7 donor livers were type 2,16 donor livers were type 3a,2 donor livers were type 3b,2 donor livers were type 3c,1 donor liver was type 4,3 donor livers were type 5a,4 donor livers were type 5b,3 donor livers were type 6.For bile duct splitting patterns of the 85 donor livers,84 donor livers were split with the main trunk of common hepatic duct preserving in the right hemiliver or right trilo

关 键 词：肝肿瘤 劈离式肝移植 肝内胆管 解剖分型 胆道造影 胆道重建 

分 类 号：R735.7[医药卫生—肿瘤]