CAJ | 학술논문

目的总结在体劈离式肝移植的临床经验.方法回顾性分析2例中国一类心脏死亡器官捐赠(DCD)供者接受供肝在体劈离手术,并将劈离后的供肝移植给4例终末期肝病患者的临床资料.供肝的劈离手术中,在保证供者循环稳定的情况下使用超声吸引刀劈离肝实质,离体劈离肝脏血管和胆道,并对供肝进行修整.供者例1的全肝质量为1800 g,劈离成右三叶供肝和左外叶供肝,右三叶供肝移植给1例成人受者,左外叶供肝经减体积后移植给1例儿童受者.供者例2的全肝质量达2100 g,在体劈离成左右半肝,分别移植给2例成人受者.结果在体劈离肝实质的手术耗时分别为1h和45 min,离体劈离肝血管和胆道的耗时分别为30 min和40 min.供肝热缺血时间均为0 min,冷缺血时间为120～360 min,移植肝质量与受者体质量比(GRWR)为1.5％～2.2％.肝移植后,1例成人受者出现门静脉血栓形成,经手术取尽门静脉血栓后,行门静脉-腔静脉搭桥,术后早期出现肝性脑病症状,经内科治疗后好转.肝移植后4例受者均恢复顺利,随访期间移植肝功能正常,均未发生排斥反应和感染并发症.结论对于中国一类供者,实施在体劈离式肝移植是安全可行的,此项术式有望成为扩展供肝来源的重要途径,详细的术前评估技术和精细的手术操作是保证肝移植顺利进行的关键.
목적 총결재체벽리식간이식적림상경험.방법 회고성분석2례중국일류심장사망기관연증(DCD)공자접수공간재체벽리수술,병장벽리후적공간이식급4례종말기간병환자적림상자료.공간적벽리수술중,재보증공자순배은정적정황하사용초성흡인도벽리간실질,리체벽리간장혈관화담도,병대공간진행수정.공자례1적전간질량위1800 g,벽리성우삼협공간화좌외협공간,우삼협공간이식급1례성인수자,좌외협공간경감체적후이식급1례인동수자.공자례2적전간질량체2100 g,재체벽리성좌우반간,분별이식급2례성인수자.결과 재체벽리간실질적수술모시분별위1h화45 min,리체벽리간혈관화담도적모시분별위30 min화40 min.공간열결혈시간균위0 min,랭결혈시간위120～360 min,이식간질량여수자체질량비(GRWR)위1.5％～2.2％.간이식후,1례성인수자출현문정맥혈전형성,경수술취진문정맥혈전후,행문정맥-강정맥탑교,술후조기출현간성뇌병증상,경내과치료후호전.간이식후4례수자균회복순리,수방기간이식간공능정상,균미발생배척반응화감염병발증.결론 대우중국일류공자,실시재체벽리식간이식시안전가행적,차항술식유망성위확전공간래원적중요도경,상세적술전평고기술화정세적수술조작시보증간이식순리진행적관건.
Objective To summarize the experience of in situ splitting liver transplantation in two cases of type 1 Chinese DCD.Method The livers in two cases of type 1 Chinese DCD were splitted in situ.The liver in the case one was splitted to one adult and one pediatric recipients,and the liver in the case two was donated to two adult recipients.The clinical data were studied retrospectively.Result In both of the procedure,hepatic parenchyma was splitted with CUSA when the donors were maintained with stable hemadymics.Vessels and biliary structures were splitted on back table.The first liver graft was splitted into right triple-lobe graft (1500 g) and left lateral lobe (200 g),and the later was reduced size to a monosegrnental graft (150 g).The second liver graft was splitted into right (1160 g) and left lobe graft (950 g) to two adult recipients.The in situ splitting duration was 1 h and 45 min,respectively.The adult recipient in the first case had portal vein thrombosis,and received portal-cava bridge.All of the 4 recipients recovered well during the early post-operative stage.Conclusion In situ splitting transplantation in type 1 Chinese DCD is safe and feasible,and it has potential to expand the donor pool.Delicate pre-operative evaluation is important to ensure the application of this procedure.