活体肝移植的若干技术改进(附26例次临床报告)

Some improvements on the surgical techniques of LDLT:a report of 26 cases

目的 探讨活体肝移植手术技术的若干改进方法。方法 通过本院 1995年 1月至2 0 0 3年 7月实施的 2 6例次活体肝移植的回顾分析 ,对活体肝移植关键手术的若干改进进行总结。主要技术改进包括 :在以包含肝中静脉为特点的扩大左半肝切取技术的基础上 ,同时采用肝静脉、腔静脉联合扩大成形吻合技术重建流出道 ;综合显微外科、自体血管移植、血管搭桥及动脉成形等相关技术行肝动脉重建 ;端端吻合重建胆道。结果 受体 :平均手术时间为 (13 2 6± 3 4 8)h ;平均术中出血为 (32 10± 2 96 7)ml;平均冷缺血时间为 (2 1± 2 0 )h ;平均移植物重量 /受体体重之比 (graft recipientweightratio ,GRWR) :1 39%± 0 4 9%。供体 :平均手术时间为 (5 9± 1 6 )h ;平均失血量为(12 10± 710 )ml;平均移植物重量 (42 9± 16 8)g。术后随访 1～ 2 6个月 ,未见流出道、肝静脉梗阻的相关并发症 ;肝动脉栓塞发生率为 12 5 % ;未见胆道相关并发症。结论 LDLT中GRWR应不低于0 85 %～ 1 0 %。联合扩大成形吻合技术重建流出道和综合显微外科、自体血管移植、血管搭桥及动脉成形等相关技术行肝动脉重建是对活体肝移植技术的重要改进。

Objective To investigate some improvements in the surgical techniques of living donor liver transplantation(LDLT). Methods A retrospective analysis was made in altogether 26 times/cases of LDLT in our department from January, 1995 to July, 2003 and some improvements on LDLT were summarized. The key techniques include: Reconstructing outflow of graft on shaping the tips of vena cava and hepatic veins;Reconstructing hepatic artery on microsurgery, auto-vessel transplantation, bridging, shaping the tips of artery, and so on;Reconstructing the hepatic duct on anastomosis in end-to-end fashion. Results Recipients: the average operative time is (13.26±3.48) h;the average blood lose in operation is (3 210±2 967)ml;the average cold ischemia time is (2.1±2.0) h;the average graft-recipient weight ratio (GRWR) is 1.39±0.49%. Donor: the average operative time is ( 5.9± 1.6) h;the average blood lose in operation is (1 210±710) ml;the average graft weight is (429± 168) g. During the postoperative 1～22 months follwed-up, no complications related to biliary tract and obstruction of outflow, hepatic veins, and the incidence of hepatic artery embolism is 12.5%. Conclusion GRWR should be more than 0.85%～1.0% at least in operation of LDLT. Reconstructing outflow of graft on shaping the tips of vena cava and hepatic veins, and reconstructing hepatic artery on microsurgery, auto-vessel transplantation, bridging, shaping the tips of artery, are both the important improvement on the surgical techniques of LDLT.