中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2014年
10期
806-810
,共5页
杭化莲%张祺琪%张建军%夏强
杭化蓮%張祺琪%張建軍%夏彊
항화련%장기기%장건군%하강
肝移植,活体%儿童%精准肝脏外科
肝移植,活體%兒童%精準肝髒外科
간이식,활체%인동%정준간장외과
Liver transplantation,living donor%Child%Precision liver surgery
目的 探讨精准肝脏外科理念在儿童活体肝移植供肝切取术中的临床价值.方法 回顾性分析2012年12月至2014年1月上海交通大学医学院附属仁济医院收治的58例儿童活体肝移植供者的临床资料.术前对供者行CT等检查,将二维影像学数据进行三维重建,评估供者肝内胆管和血管情况,并对肝左动脉和肝左静脉解剖结构进行分型,测算供者标准肝脏体积、拟切取肝脏体积和受者标准肝脏体积,模拟手术操作,制订手术方案.采取精准肝切除切取供肝.采用门诊和电话方式进行随访,随访时间截至2014年4月.结果 58例儿童活体肝移植供者术前CT血管造影检查示肝左动脉Ⅰ型28例、Ⅱ型10例、Ⅲ型20例、无Ⅳ型供者;肝左静脉Ⅰ型35例、Ⅱ型23例.三维重建预测拟切取肝脏体积为(243±65) mL.58例供者均成功完成供肝切取术,其中7例为左半肝切取,51例为肝左外叶切取.2例供者行胆囊切除.术中实际切取肝脏体积为(255±59) mL,拟切取肝脏体积平均误差率为4.94％.移植物质量与受者体质量比为3.3％±1.0％.手术时间为(260±89)min,术中出血量为(181±35)mL,仅1例供者术中输RBC 2 U.供者术后胃肠功能恢复时间为(2.0±1.1)d,术后拔除引流管时间为(3.0±1.2)d,术后住院时间为(7±3)d,出院时所有供者血清WBC、Hb、ALT、AST、TBil、DBil、AIb等指标水平正常.2例供者术后发生并发症,分别为切口少量渗血和脂肪液化,均经对症治疗后痊愈.58例儿童活体肝移植供者术后均获得随访,中位随访时间为8.7个月.供者恢复良好,随访期间无并发症发生.结论 精准肝脏外科理念应用于儿童活体肝移植供肝切取术,切取准确率高、供者肝功能损害小、术后并发症少、恢复快.
目的 探討精準肝髒外科理唸在兒童活體肝移植供肝切取術中的臨床價值.方法 迴顧性分析2012年12月至2014年1月上海交通大學醫學院附屬仁濟醫院收治的58例兒童活體肝移植供者的臨床資料.術前對供者行CT等檢查,將二維影像學數據進行三維重建,評估供者肝內膽管和血管情況,併對肝左動脈和肝左靜脈解剖結構進行分型,測算供者標準肝髒體積、擬切取肝髒體積和受者標準肝髒體積,模擬手術操作,製訂手術方案.採取精準肝切除切取供肝.採用門診和電話方式進行隨訪,隨訪時間截至2014年4月.結果 58例兒童活體肝移植供者術前CT血管造影檢查示肝左動脈Ⅰ型28例、Ⅱ型10例、Ⅲ型20例、無Ⅳ型供者;肝左靜脈Ⅰ型35例、Ⅱ型23例.三維重建預測擬切取肝髒體積為(243±65) mL.58例供者均成功完成供肝切取術,其中7例為左半肝切取,51例為肝左外葉切取.2例供者行膽囊切除.術中實際切取肝髒體積為(255±59) mL,擬切取肝髒體積平均誤差率為4.94％.移植物質量與受者體質量比為3.3％±1.0％.手術時間為(260±89)min,術中齣血量為(181±35)mL,僅1例供者術中輸RBC 2 U.供者術後胃腸功能恢複時間為(2.0±1.1)d,術後拔除引流管時間為(3.0±1.2)d,術後住院時間為(7±3)d,齣院時所有供者血清WBC、Hb、ALT、AST、TBil、DBil、AIb等指標水平正常.2例供者術後髮生併髮癥,分彆為切口少量滲血和脂肪液化,均經對癥治療後痊愈.58例兒童活體肝移植供者術後均穫得隨訪,中位隨訪時間為8.7箇月.供者恢複良好,隨訪期間無併髮癥髮生.結論 精準肝髒外科理唸應用于兒童活體肝移植供肝切取術,切取準確率高、供者肝功能損害小、術後併髮癥少、恢複快.
목적 탐토정준간장외과이념재인동활체간이식공간절취술중적림상개치.방법 회고성분석2012년12월지2014년1월상해교통대학의학원부속인제의원수치적58례인동활체간이식공자적림상자료.술전대공자행CT등검사,장이유영상학수거진행삼유중건,평고공자간내담관화혈관정황,병대간좌동맥화간좌정맥해부결구진행분형,측산공자표준간장체적、의절취간장체적화수자표준간장체적,모의수술조작,제정수술방안.채취정준간절제절취공간.채용문진화전화방식진행수방,수방시간절지2014년4월.결과 58례인동활체간이식공자술전CT혈관조영검사시간좌동맥Ⅰ형28례、Ⅱ형10례、Ⅲ형20례、무Ⅳ형공자;간좌정맥Ⅰ형35례、Ⅱ형23례.삼유중건예측의절취간장체적위(243±65) mL.58례공자균성공완성공간절취술,기중7례위좌반간절취,51례위간좌외협절취.2례공자행담낭절제.술중실제절취간장체적위(255±59) mL,의절취간장체적평균오차솔위4.94％.이식물질량여수자체질량비위3.3％±1.0％.수술시간위(260±89)min,술중출혈량위(181±35)mL,부1례공자술중수RBC 2 U.공자술후위장공능회복시간위(2.0±1.1)d,술후발제인류관시간위(3.0±1.2)d,술후주원시간위(7±3)d,출원시소유공자혈청WBC、Hb、ALT、AST、TBil、DBil、AIb등지표수평정상.2례공자술후발생병발증,분별위절구소량삼혈화지방액화,균경대증치료후전유.58례인동활체간이식공자술후균획득수방,중위수방시간위8.7개월.공자회복량호,수방기간무병발증발생.결론 정준간장외과이념응용우인동활체간이식공간절취술,절취준학솔고、공자간공능손해소、술후병발증소、회복쾌.
Objective To investigate the clinical value of the precision liver surgery in the liver graft procurement for pediatric living donor liver transplantation.Methods The clinical data of 58 living donors of left hepatic lobe graft who were admitted to the Renji Hospital of Shanghai Jiaotong University from December 2012 to January 2014 were retrospectively analyzed retrospectively from December 2012 to January 2014.All the donors donated voluntarily and gratuitously and were approved by the ethics committee of the hospital.All the donors received computed tomography (CT),and the two dimensional data were converted to three dimensional images for evaluating the intrahepatic bile ducts and blood vessles,and the typs of the left hepatic arteries and veins were determined.The donor's liver graft volume was assessed by CT before operation.The standard liver volume of the donors and the recipients,and the volume of liver to be reseeted and the total liver volume were measured.A virtual surgery was conducted for designing the actual surgery.The liver graft was resected with the precision liver surgery technique.Patients were followed up by the out-patient examination and phone call till April 2014.Results The results of CT angiography confirmed that 28 donors were with type Ⅰ left hepatic artery,10 with type Ⅱ left hepatic artery and 20 with type Ⅲ left hepatic artery; 35 patients were with type Ⅰ left hepatic vein and 23 with type Ⅱ left hepatic vein.The left-lobe volume estimated by CT was (243 ± 65) mL.Liver graft procurement was successfully carried out on the 58 donors,including 7 left hemihepatectomy and 51 left lateral lobectomy.Two donors received cholecystectomy concomitantly.The actual volume of liver resected was (255 ±59) mL,and the error rate of the liver volume to be resected was 4.94％.The weight of the liver graft to the body weight of the recipient was 3.3％ ± 1.0％.The operation time and the volume of blood loss were (260 ± 89) minutes and (181 ± 35)mL,respectively.One donor received red blood cell infusion of 2 U.The time for gastrointestinal function recovery was (2.0 ± 1.1) days,and the time of drainage tube pull-off was (3.0 ± 1.2) days.The duration of postoperative stay was (7 ± 3) days.The white blood cells,hemoglobin,alanine transaminase,aspartate transaminase,total bilirubin,direct bilirubin and albumin were at the normal levels at the discharge.Two donors were complicated by incisional bleeding and fat liquefaction,and they were cured by symptomatic treatment.All the donors were followed up for a median time of 8.7 months.The donors were recovered well without complications during the follow-up.Conclusions Liver graft procurement guided by precision liver surgery has the advantages of high accurate rate,little injury to the liver of the donors,few postoperative complications and quick recovery of the donors.
