CAJ | 학술논문

目的报道1例减体积肝段移植治疗儿童先天性胆管闭锁的病例。方法回顾性总结天津市第一中心医院2014年3月为1例先天性胆管闭锁的患儿进行的亲属活体肝移植术，患儿年龄5个月，体重7 kg，供体为患儿母亲，术中切取供肝重量为360 g，移植物重量受体体重比（GRWR）偏大（5.14%），手术切取供体肝脏左外侧叶，并在体外对供肝进行减体积的肝切除，受体行保留下腔静脉的全肝切除术，然后行供肝原位移植。结果供体手术时间为6小时30分钟，术中出血150 ml，术后1周顺利恢复出院。受体手术时间为8.5小时，无肝期为50分钟；供肝重量为360 g，减体积后为260 g，GRWR降低为3.71%。免疫抑制采用术中甲泼尼龙诱导，术后三联免疫抑制方案（他克莫司+霉酚酸酯+甲泼尼龙）。受者术后25天转氨酶及胆红素指标降至正常，腹部超声提示移植肝血管及血流未见异常，移植肝体积逐月增大。受者腹部伤口Ⅰ级愈合，于术后35天出院。肝移植术后随访6个月，供、受者均未出现任何并发症，受体术后体重迅速增加。结论针对大体积供肝的儿童活体肝移植，采用减体积肝段移植是有效且安全的选择，前提是在术前对供肝血管影像学检查的准确评估以及受者围手术期的严格管理。
목적보도1례감체적간단이식치료인동선천성담관폐쇄적병례。방법회고성총결천진시제일중심의원2014년3월위1례선천성담관폐쇄적환인진행적친속활체간이식술，환인년령5개월，체중7 kg，공체위환인모친，술중절취공간중량위360 g，이식물중량수체체중비（GRWR）편대（5.14%），수술절취공체간장좌외측협，병재체외대공간진행감체적적간절제，수체행보류하강정맥적전간절제술，연후행공간원위이식。결과공체수술시간위6소시30분종，술중출혈150 ml，술후1주순리회복출원。수체수술시간위8.5소시，무간기위50분종；공간중량위360 g，감체적후위260 g，GRWR강저위3.71%。면역억제채용술중갑발니룡유도，술후삼련면역억제방안（타극막사+매분산지+갑발니룡）。수자술후25천전안매급담홍소지표강지정상，복부초성제시이식간혈관급혈류미견이상，이식간체적축월증대。수자복부상구Ⅰ급유합，우술후35천출원。간이식술후수방6개월，공、수자균미출현임하병발증，수체술후체중신속증가。결론침대대체적공간적인동활체간이식，채용감체적간단이식시유효차안전적선택，전제시재술전대공간혈관영상학검사적준학평고이급수자위수술기적엄격관리。
Objective To report one case of reduced-size liver transplantation in the treatment of children with congenital segment reported cases of biliary atresia. Methods Reduced monosegmental liver transplantation was performed for one patient suffered congenital biliary atresia in our hospital in March 2014. The patient was 5 months old and 7 kg in weight. His mother donated her left lateral liver. Due to graft-to-recipient weight ratio(GRWR)was too high(5.14%),the left lateral donor liver was harvested and further reduced size in vitro. The diseased liver of patient was removed with the vena cava reserved,then orthotopic liver transplantation was performed. Results Donor operative time was 6.5 hours and total amount of bleeding was 150 ml,donor recovered well and discharged 1 week after operation. Recipient operative time was 8.5 hours with 50 minutes of an-hepatic period. Reduced-size graft was 260 g and GRWR was reduced to 3.71%. Intraoperative methylprednisolone induction and triple immunosuppressive regimen(tacrolimus+mycophenolate mofetil+methylprednisolone)were applied for recipient. Recipient condition was well and liver function return to normal level 25 days after operation. Abdominal ultrasound suggest normal hemodynamics and increasing volume of graft liver. Recipient was discharged 35 days after operation and abdominal wound healed with A level. Both donor and recipient were followed up 6 months without any complications. Conclusion To prevent complications associated with large-for-size grafts,further graft reduction could be necessary to overcome the large-for-size graft syndrome,the reduced monosegmental liver transplantation <br> is an safe and effective selection which was based on accurate preoperative radiological assessment of the graft and excellent perioperative care and management to the patient.