小体积左半肝原位辅助性部分肝移植治疗失代偿期肝硬化的临床应用价值  

Clinical application value of small-for-size left lobe liver auxiliary partial orthotopic liver transplantation for treatment of decompensated cirrhosis

作　　者：唐刚 孔凌祥 杨家印[1,2] TANG Gang;KONG Lingxiang;YANG Jiayin(Organ Transplantation Center,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Department of General Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西医院肝移植中心器官移植中心,成都610041 [2]四川大学华西医院普通外科,成都610041

出　　处：《中国普外基础与临床杂志》2025年第3期313-318,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：国家科技重大专项项目(项目编号:2023ZD0502400);四川省科技计划项目-重点研发项目(项目编号:2024YFFK0197)。

摘　　要：目的探讨小体积左半肝原位辅助性部分肝移植(auxiliary partial orthotopic liver transplantation,APOLT)治疗失代偿期肝硬化的临床应用价值。方法回顾性分析2023年于四川大学华西医院肝脏移植中心接受小体积左半肝APOLT的4例患者的术前及术后临床资料。结果4例受者中1例为代谢性肝脏疾病肝硬化患者,其余3例为乙型肝炎肝硬化患者,均表现为失代偿期肝硬化。经术前评估,移植物受者体质量比率均<0.6%,受者均进行左半肝切除。3例受者接受活体左半肝移植,1例受者接受公民逝世后器官捐献劈离式左半肝移植。经APOLT治疗,4例受者均存活良好,其中有1例发生排斥反应,经调整抗排斥治疗后好转。3例乙型肝炎肝硬化受者均接受核苷类药物和乙型肝炎免疫球蛋白治疗,于随访结束时乙型肝炎病毒DNA均阴性,其中1例乙型肝炎肝硬化受者于术后1个月时进行移植物穿刺活检进一步检测乙型肝炎病毒呈阴性。结论从本组病例总结结果看,小体积左半肝APOLT治疗失代偿期肝硬化可行,有希望扩大供肝池,能使更多终末期肝脏疾病模型评分低的失代偿期肝硬化患者获益。Objective To investigate the clinical value of small-for-size left lobe liver auxiliary partial orthotopic liver transplantation(APOLT)in the treatment of decompensated cirrhosis.Method The preoperative and postoperative clinical data of 4 patients who received small-for-size left lobe liver APOLT in 2023 were retrospectively described and analyzed.Results One patient suffered metabolic liver disease cirrhosis and the other three suffered hepatitis B cirrhosis,all of whom presented with decompensated cirrhosis.Preoperative evaluation showed that the graft-to-recipient weight ratio was less than 0.6%.All recipients underwent left hemihepatectomy.The grafts were derived from living donors in 3 cases,from donation after citizen death in 1 case.After APOLT treatment,4 patients and grafts survived,1 patient experienced transplantation rejection and recovered after modified anti-rejection therapy.Three patients with hepatitis B cirrhosis were treated with nucleoside analogues and hepatitis B immunoglobulin,the hepatitis B virus DNA was negative at the end of follow-up,one of three patients with hepatitis B cirrhosis showed negative results for hepatitis B virus in the graft biopsy at month one after surgery.Conclusions From the summary results of these cases,small-for-size left lobe liver APOLT can be used to treat decompensated cirrhosis.The application and popularization of this treatment regimen is expected to expand the donor pool and benefit more decompensated cirrhosis patients with lower Model for End-stage Liver Disease score.

关 键 词：辅助性部分肝移植 失代偿期肝硬化 小体积移植物 乙型肝炎 

分 类 号：R57[医药卫生—消化系统]