供肝质量快速评价方法的探讨(附6例报告)  

Discussion on rapid evaluation of donor liver quality: a report of 6 cases

作　　者：杨致富[1] 韩德恩[2] 陈大志[3] 张新宇[2] 

机构地区：[1]连云港市第一人民医院普外科,江苏省222002 [2]哈尔滨医科大学第二临床医学院普外科,150086 [3]北京朝阳医院肝移植中心,100020

出　　处：《中华肝胆外科杂志》2003年第9期527-529,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的　探讨即时切取供肝质量的快速评价方法。方法　即时切取供肝前 ,取静脉血行全血细胞计数及肝功能检查 ;切肝时肉眼观察肝表面情况 ;取肝组织做快速石蜡切片检查 ;灌注时测定供肝的门静脉灌注压力和流量。结果　用上述四种方法对供肝质量进行综合评价 ,可疑质量不佳1例 ,植入后出现原发性无功能 ,评价供肝质量不佳 1例未植入 ,其余 4例供肝质量评价结果良好 ,供肝植入后近期肝功能良好。结论　供体血生化检查对评价供肝质量具有重要价值。肉眼观察直观、明了 ,对明显病变者可即刻放弃。对可疑肝组织形态有改变者快速石蜡切片检查能提供取舍证据。门静脉灌注压可间接反映供肝质量 ,对评价供肝质量更具否定意义。四种方法同时或选择性的应用可快速、准确评价供肝质量。Objective To seek an effective method for rapid evaluation of donor liver quality. Methods Routine blood test and liver function examination were performed before excision of the donor blood. Upon the excision, the liver surface was grossly observed and the liver tissue fixed with paraffin, sliced and observed under the microscope. During cold perfusion, the pressure and flux of the portal vein were measured. Results Of the 6 donor livers, 1 was suspicious of poor quality and had no function after transplantation, 1 was not transplanted due to its poor quality and the left 4 were of good quality and worked well after the transplantation. Conclusions Routine blood test of the donor is of great value for evaluating the donor liver quality. Gross observation is direct and clear. For those donor livers with suspected histomorphological changes, rapid fixation with paraffin and microscopic observation can timely provide evidence for selection. Measurement of the portal vein pressure can indirectly reflect the donor liver quality, which is more meaningful for evaluation of the donor liver quality. Using the four methods together or selectively is valuable for rapid and accurate evaluation of the donor liver quality.

关 键 词：供肝质量 快速评价 肝功能检查 肝移植 全血细胞计数 

分 类 号：R657.3[医药卫生—外科学]