劈离式肝移植中供肝分离的手术经验

Experience in hepatic graft dividing in split liver transplantation

目的探讨劈离式肝移植中供肝分离的手术经验.方法自2004年3月1日至9月1日,共计施行了10例体外供肝的劈离,将其分为左肝外侧叶(Ⅱ、Ⅲ段)和扩大右半肝(Ⅰ、Ⅳ～Ⅷ段)两部分,并为19位病人施行了劈离式肝移植.供体的平均年龄为32.7岁(15～51岁),平均体重64.5kg(45～75kg),ICU平均救治时间为2.4 d(1～8 d).结果劈离前整体供肝和劈离后左肝外侧叶的平均重量分别为1322.6 g(956～1665 g)和281.8 g(198～373 g),后者与前者的平均比值为0.215(0.178～0.274).左肝外侧叶部分的移植物与受体重量比(GRWR)的平均值为2.44%(1.22%～5.41%),而扩大右半肝部分GRWR的平均值为1.73%(1.31%～2.30%).供肝劈离平均花费的时间为105 min(85～135 min).共出现5例解剖变异,包括左肝静脉变异2例、肝动脉变异2例、胆管变异1例.结论劈离式肝移植已经成为扩大供肝来源的一种成熟的外科技术,且效果满意.在供肝劈离中需要正确应对各种可能的解剖变异,尤其是左肝静脉、左肝动脉和胆管的变异.

Objective To summarize the experience in hepatic graft dividing in split liver transplantation. Methods From March 1 to September 1 of the year 204, 10 cases of hepatic grafts were split ex situ into left lateral lobe （segment Ⅱ , Ⅲ ） and right extended lobe （segment Ⅰ , Ⅳ-Ⅷ） in Medical School of Hanover, Germany, and thereafter a total of 19 cases split liver transplantation was performed. The average age, body weight and ICU stay of the donors was 32.7 yr （15-51 yr）, 64.5 kg （45-75 kg） and 2.4 d （1 8 d）, respectively. Results The mean weight of the whole graft and the left lateral lobe was 1322.6 g （956-1665 g） and 281.8 g （198 373 g）, respectively. The mean ratio of left lateral lobe to whole graft was 0. 215（0. 178-0. 274）. The average C-RWR of the left lateral lobe and the right extended lobe reached 2. 44% （1.22-5.41%） and 1.73% （1.31-2.30%）, respectively. On average it took approximately 105 min （85-135 min） to split the hepatic graft. Five cases of anatomic variation occurred including, 2 cases of left hepatic vein, 2 cases of left hepatic artery and 1 case of bile duct. Conclusions Split liver transplantation has become a mature surgical technique to expand the donor pool with promising results. In the process of graft splitting, close attention needs to be paid to those potential anatomic variations, especially those of the left hepatic vein, left hepatic artery and bile duct.