婴幼儿亲体部分肝移植

Living related liver transplantation in infants

目的回顾性分析我院2002年10月-2005年10月6例婴幼儿亲体部分肝移植临床疗效。方法婴幼儿亲体部分肝移植6例，年龄9个月～3岁，男3例，女3例；手术时体重为7～16kg。胆道闭锁Kasai术后肝硬化腹水4例，先天性肝内胆汁淤积症、肝硬化腹水1例，药物性肝炎1例。随访时间为6～36个月。结果供肝提供者分别为母2例，父4例，提供左外叶肝，平均住院7d，无并发症。5例生存，最长36个月。1例因凝血功能障碍，术后24h肾功能衰竭、肺出血死亡。术后免疫治疗药物包括甲基强的松龙、FK506和赛尼派。术后并发症为2例胆瘘，术后出血、再次进腹止血1例，肺部感染1例。结论婴儿期进行部分活体肝移植，扩大了供体来源，临床疗效较好，是婴儿终末期肝病有效的治疗方法。

Objective To present our experience of living related liver transplantation （LRLT） in infants. Methods Six patients underwent LRLT between Oct. 2002 and Oct. 2005 in Children＇s Hospital, and Zhongshan Hospital, Fudan University, Shanghai. These 6 patients （3 boys and 3 girls） aged from 9 months to 3 years whose body weight at the time of operation was 7 to16 kg. Four cases suffered from biliary atresia, 1 with congenital cholestasis and the other one with medicated hepatitis. All patients were followed up from 6 months to 3 years. Results The living donors were 2 mothers and 4 fathers with ABO compatible with the recipients. Donor organs were the left lateral lobe grafts. Average length of stay was 7 days for the donor group without any complications. Postoperative immunosuppression included prednisone, FK505, and the anti IL2 receptor antibody. Five cases were survival and 1 died from postoperative bleeding due to renal failure. The longest survival time was 36 months during follow-up term Postoperative complications include biliary leakage （2）, bleeding （1）, and postoperative pneumonia （ 1 ）. Conclusions LRLT for infants in our hospitals has gained the excellent short-median survival with good graft function. Living donation provides a critical role in the balance between the increasing needs of the liver and the decreasing resources in pediatric group.