在体与离体不同劈离方式在完全劈离式肝移植中的对比研究  

Comparative study of in situ and ex situ liver splitting techniques in split liver transplantation

作　　者：冯斐 林正伟 叶莹鹏 朱宏达 杨勇[1] 陆才德[1] 房炯泽 Feng Fei;Lin Zhengwei;Ye Yingpeng;Zhu Hongda;Yang Yong;Lu Caide;Fang Jiongze(Department of Hepatobiliary and Pancreatic Surgery,the Affiliated Lihuili Hospital of Ningbo University,Ningbo315041,China)

机构地区：[1]宁波大学附属李惠利医院肝胆胰外科,宁波315041

出　　处：《中华普通外科杂志》2025年第2期131-138,共8页Chinese Journal of General Surgery

基　　金：宁波市重点研发计划项目(2024Z179);宁波市公益性研究计划项目(2024S155);宁波市医疗卫生高端团队重大攻坚项目(2024020818)。

摘　　要：目的比较供肝在体和离体劈离术式对完全劈离式肝移植近期预后的影响。方法回顾性分析2021年3月至2023年12月宁波大学附属李惠利医院81例成人劈离式肝移植受体和42例供体的围手术期及随访数据,将其分为离体劈离组和在体劈离组,对近期并发症进行比较。结果截至2023年12月,随访1~30个月,中位随访时间19个月。在体劈离组冷、热缺血时间显著低于离体组(均P<0.001)。在体劈离组术后AST和ALT峰值均低于离体组(均P<0.01),但胆道并发症率较高(13例比1例,P=0.028)。结论在体劈离较离体劈离冷热缺血时间缩短、肝细胞损伤更小,但胆道并发症发生率更高。Objective:To compare the effect of in situ and ex situ liver splitting techniques on the short-term outcomes of complete split liver transplantation.Methods:A retrospective analysis was conducted on the perioperative and follow-up data of 81 adult split liver transplant recipients and 42 donors at Ningbo University's Affiliated Lihuili Hospital from Mar 2021 to Dec 2023.Patients were divided into the ex situ and in situ splitting groups,and short-term complications were compared.Results:As of Dec 2023,the follow-up duration ranged from 1 to 30 months,with a median of 19 months.Cold and warm ischemia times were significantly shorter in the in situ splitting group compared to the ex situ group(P<0.001).Postoperative peak levels of AST and ALT were also lower in the in situ splitting group(P<0.01).However,the incidence of biliary complications was higher in the in situ splitting group(13 cases vs.1 case,P=0.028).Conclusions:Compared to ex situ splitting,in situ splitting significantly reduces cold and warm ischemia times and results in less hepatocellular injury.However,it is associated with a higher incidence of biliary complications.

关 键 词：肝移植 手术后并发症 成人 完全左右半肝 

分 类 号：R657.3[医药卫生—外科学]