成人间活体肝移植治疗终末期肝病

Adult to adult living donor liver transplantation for decompensated end-stage liver disease

目的 探讨成人间活体肝移植治疗终末期肝病的方法及技术要点。方法 回顾性分析2000年9月-2004年9月成人间活体肝移植9例患者的临床资料。其中，左半肝（第Ⅱ、Ⅲ、Ⅳ段，包括肝中静脉）移植3例，右半肝（第Ⅴ、Ⅵ、Ⅶ、Ⅷ段，不包括肝中静脉）移植6例。结果 9例供体无手术死亡，平均手术时间（6．2±1．4）h；术中出血300-1200ml；术后胆漏1例，切口脂肪液化1例；随访6-12个月，无远期并发症，全部于术后1-2个月恢复工作。受体手术时间5-11h；采用改良方法重建移植肝流出道、显微技术重建肝动脉、端端吻合重建胆道；术中出血800-7000ml；移植物冷缺血时间（1．9±0．5）h；无肝期时间（98±26）min；移植物重量与受体体重比为（1．20±0．26）％。受体术后并发腹腔内局限性胆漏1例；死亡1例，长期存活8例。结论 成人间活体肝移植是解决供肝短缺、治疗终末期肝病的有效方法，同时能相对保证供体的安全；管道重建是手术成功的关键。

Objective To summarize the clinical experience and some principal surgical techniques of adult to adult living donor liver transplantation （ALDLT）. Methods The clinical data of 9 patients receiving ALI）LT from September 2000 to September 2004 in liver transplantation center in the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively. The left lobe （segments Ⅱ、Ⅲ、Ⅳ , including the middle hepatic veins） was transplanted in 3 patients, and the right lobe （segments Ⅴ、Ⅵ、Ⅶ、Ⅷ , not including the middle hepatic veins） was transplanted in 6 patients. Results There was no operative death in donors. The median operative time was （6.2±1.4） hours. The blood loss ranged from 300 to 1 200 ml. Postoperative complications included biliary fistula （1 donor ） and wound fat liquefaction （1 donor）. They were followed up for 6-12 months, and no long-term complications were found. In recipients, the operating time ranged from 5 to 11 hours. The blood loss ranged from 800 to 7 000 ml. Modified outflow reconstruction method, microvascular reconstruction of the hepatic artery and duct-to-duct biliary reconstruction were performed in recipients. The median cold ischemic time of the grafts was （1.9±0.5） hours. The mean non hepatic stage of recipients was （98 ±26） minutes. Graft/recipient weight ratio （GRWR） was （1.20±0.26）%. One recipient presented postoperative complication of biliary fistula. One recipient died of serious infection 1 month postoperatively. The other 8 recipients enjoyed long-term survival. Conclusion The procedure of ALDLT is an effective method in the treatment of decompensated end-stage liver disease, and it is relatively safe for the donor. Reconstruction of vessels is the key surgical technique in the operative procedure.