在体劈离式儿童肝脏移植的单中心研究

In situ split liver transplantation in pediatric recipients:single-center experience

目的总结在体劈离式儿童肝脏移植的临床经验。方法回顾性分析2020年5月至2021年3月浙江大学医学院附属第二医院实施的30例在体劈离式儿童肝脏移植的供体、受体资料。30例供体均为"中国一类"脑死亡器官捐献(donation after brain death,DBD)供体,平均年龄42岁;脑死亡原因:颅脑外伤15例,脑出血13例,呼吸心跳骤停2例。在体劈离均将供肝分为左外叶(Ⅱ~Ⅲ段)和扩大的右三叶(Ⅰ段+Ⅳ~Ⅷ段),均采用背驮式肝移植。观察手术效果及患儿随访情况。结果随访至2021年9月(平均随访10.2个月),30例在体劈离儿童肝移植受体无一例出现血管相关并发症(动脉栓塞、门静脉狭窄、流出道梗阻等);出现腹腔出血1例,为肝脏断面出血,予手术探查止血;Roux-en-Y胆肠吻合口狭窄2例,予介入经皮肝穿刺胆道引流(percutaneous transhepatic cholangial drainage,PTCD)行球囊扩张后好转。术后平均入住监护室时间为80 h,平均住院时间为22.8 d。移植物存活率96.6%(29/30),1例术后出现移植物失功,行二次移植。结论在体劈离儿童肝脏移植安全有效,可扩大供肝来源,缓解儿童肝脏移植器官短缺的问题。

Objective To explore the clinical efficacy and safety of in situ split liver transplantation(ISSLT)with organ donation from Brain Death Donor.Methods A retrospective analysis was performed on series of 30cases of pediatric recipient using in situ split liver transplant technique during May 2020 to September 2021.30 donors were all from brain death,the average age was 42 years.Cause of death of 15 donors was traumatic brain injury(n=15),cerebral hemorrhage(n=13)and breath&cardiac arrest(n=2).Liver was split into left(Ⅱ-Ⅲ)and right(Ⅰ+Ⅳ-Ⅷ)lobes.Piggyback liver transplantation was employed.Results During follow-ups until September 2021,there was no such vascular-related complications as hepatic artery thrombosis,portal vein stricture or outflow obstruction.There were hemorrhage(n=1)and biliary complication(n=2).The average postoperative stay of intensive care unit(ICU)was 80h and average hospitalization duration 22.8 days.Conclusion After thorough evaluations,ISSLT may be safely performed in brain-dead donors with excellent postoperative outcomes and improved utilization rate of donor livers.