中华肝脏外科手术学电子杂志
中華肝髒外科手術學電子雜誌
중화간장외과수술학전자잡지
CHINESE JOURNAL OF HEPATIC SURGERY(ELECTRONIC EDITION)
2014年
3期
144-147
,共4页
陈新国%李威%吴风东%邹卫龙%刘煜%王毅%臧运金%朱晓丹%关兆杰%范宁%岳扬%沈中阳
陳新國%李威%吳風東%鄒衛龍%劉煜%王毅%臧運金%硃曉丹%關兆傑%範寧%嶽颺%瀋中暘
진신국%리위%오풍동%추위룡%류욱%왕의%장운금%주효단%관조걸%범저%악양%침중양
肝移植%劈离式%术后并发症
肝移植%劈離式%術後併髮癥
간이식%벽리식%술후병발증
Liver transplantation%Splitting%Postoperative complications
目的探讨劈离式肝移植（SLT）的安全性及疗效。方法回顾性研究2008年1月至2013年8月在武警总医院器官移植研究所行SLT的10例供者和19例受者临床资料。受者中男9例，女10例；年龄7个月～62岁，中位年龄31岁；儿童9例，成人10例；移植物重量与受体体重比（GRWR）为1.0%～4.3%。所有患者均签署知情同意书，符合医学伦理学规定。10例尸体供肝均采用体外劈离的方法。9例供肝劈离后分别移植给9例儿童和8例成人，肝左外叶（Ⅱ、Ⅲ段）移植给儿童受者，扩大右半肝（Ⅰ、Ⅳ～Ⅷ段）移植给成人受者；另1例供肝实施左、右半肝劈离，移植给2例成人。接受肝左外叶移植的9例儿童及1例接受右半肝的成人受者行背驮式肝移植术，接受扩大右半肝移植的8例成人及接受左半肝移植的1例成人受者行经典原位肝移植术。观察受者围手术期死亡及并发症发生情况，出院后受者接受定期随访，观察存活情况。结果19例受者均顺利完成手术，17例痊愈出院，围手术期死亡2例。2例死亡受者均为儿童，其中1例术后2周死于感染性休克，另1例再次肝移植术后2d死于原发性移植肝无功能。2例儿童受者发生肝断面胆漏，行穿刺引流后治愈。1例胆管细胞型肝癌成人受者术后15个月死于肺、骨多发转移。结论 SLT是一种安全、可行的肝移植术式，在一定程度上可缓解供肝短缺的问题。
目的探討劈離式肝移植（SLT）的安全性及療效。方法迴顧性研究2008年1月至2013年8月在武警總醫院器官移植研究所行SLT的10例供者和19例受者臨床資料。受者中男9例，女10例；年齡7箇月～62歲，中位年齡31歲；兒童9例，成人10例；移植物重量與受體體重比（GRWR）為1.0%～4.3%。所有患者均籤署知情同意書，符閤醫學倫理學規定。10例尸體供肝均採用體外劈離的方法。9例供肝劈離後分彆移植給9例兒童和8例成人，肝左外葉（Ⅱ、Ⅲ段）移植給兒童受者，擴大右半肝（Ⅰ、Ⅳ～Ⅷ段）移植給成人受者；另1例供肝實施左、右半肝劈離，移植給2例成人。接受肝左外葉移植的9例兒童及1例接受右半肝的成人受者行揹馱式肝移植術，接受擴大右半肝移植的8例成人及接受左半肝移植的1例成人受者行經典原位肝移植術。觀察受者圍手術期死亡及併髮癥髮生情況，齣院後受者接受定期隨訪，觀察存活情況。結果19例受者均順利完成手術，17例痊愈齣院，圍手術期死亡2例。2例死亡受者均為兒童，其中1例術後2週死于感染性休剋，另1例再次肝移植術後2d死于原髮性移植肝無功能。2例兒童受者髮生肝斷麵膽漏，行穿刺引流後治愈。1例膽管細胞型肝癌成人受者術後15箇月死于肺、骨多髮轉移。結論 SLT是一種安全、可行的肝移植術式，在一定程度上可緩解供肝短缺的問題。
목적탐토벽리식간이식（SLT）적안전성급료효。방법회고성연구2008년1월지2013년8월재무경총의원기관이식연구소행SLT적10례공자화19례수자림상자료。수자중남9례，녀10례；년령7개월～62세，중위년령31세；인동9례，성인10례；이식물중량여수체체중비（GRWR）위1.0%～4.3%。소유환자균첨서지정동의서，부합의학윤리학규정。10례시체공간균채용체외벽리적방법。9례공간벽리후분별이식급9례인동화8례성인，간좌외협（Ⅱ、Ⅲ단）이식급인동수자，확대우반간（Ⅰ、Ⅳ～Ⅷ단）이식급성인수자；령1례공간실시좌、우반간벽리，이식급2례성인。접수간좌외협이식적9례인동급1례접수우반간적성인수자행배타식간이식술，접수확대우반간이식적8례성인급접수좌반간이식적1례성인수자행경전원위간이식술。관찰수자위수술기사망급병발증발생정황，출원후수자접수정기수방，관찰존활정황。결과19례수자균순리완성수술，17례전유출원，위수술기사망2례。2례사망수자균위인동，기중1례술후2주사우감염성휴극，령1례재차간이식술후2d사우원발성이식간무공능。2례인동수자발생간단면담루，행천자인류후치유。1례담관세포형간암성인수자술후15개월사우폐、골다발전이。결론 SLT시일충안전、가행적간이식술식，재일정정도상가완해공간단결적문제。
Objective To investigate the safety and efficacy of splitting liver transplantation (SLT). Methods Clinical data of 10 donors and 19 recipients undergoing SLT in Institute of Organ Transplantation, General Hospital of Chinese People's Armed Police Forces from January 2008 to August 2013 were analyzed retrospectively. Of these 19 recipients, 9 were male, 10 were female and 9 were children,10 were adults. The age ranged from 7 months to 62 years with a median age of 31 years. The graft recipient weigh ratio (GRWR) was 1.0%to 4.3%. The informed consents of all patients were obtained and the ethical committee approval was received. The 10 cadaveric donor livers were split in vitro, in which 9 pair grafts were transplanted in 9 children and 8 adults respectively. The left lateral lobes (segmentⅡ,Ⅲ) were transplanted in children and the extended right lobes (segmentⅠ,Ⅳ-Ⅷ) in adults. The other donor liver was split in left and right half lobes and were transplanted in 2 adults. Piggyback liver transplantation was performed in the 9 children receiving left lateral lobes and 1 adult receiving right half lobe. Classic orthotopic liver transplantation was performed in the 8 adults receiving extended right lobes and 1 adult receiving left half lobe. Peri-operative death and complications of the patients were observed. The patients were followed up regularly for observing the survival situation. Results All the operations of 19 recipients were completed successfully. Seventeen cases were cured and discharged from hospital and 2 cases died during the peri-operative period. The 2 dead cases were both children. One died of septic shock 2 weeks after operation and the other died of primary liver graft nonfunction 2 d after liver retransplantation. Biliary leak of liver section occurred in 2 pediatric recipients and was cured by puncture drainage. One adult recipient with intrahepatic cholangiocarcinoma died of lung and bone multiple metastases 15 months after operation. Conclusions SLT is a safe and feasible transplant operation and it can help to alleviate the shortage of donor livers to some extent.
