成人活体肝移植单中心56例临床报告

Clinical study of adult-to-adult living donor fiver transplantation:a report of 56 cases

目的探讨成人间右半肝移植手术中保证供、受者安全的方法。方法 2002年1月至2006年9月四川大学华西医院对56例受者施行了成人右半肝移植,其中52例不含肝中静脉,4例双供肝肝移植。受者原发病为乙型肝炎肝硬化35例(62.5%,含急性肝功能衰竭12例),肝细胞肝癌17例(30.4%),其他4例;MELD 评分>25分者10例。供者常规行三维 CT 计算全肝体积及右半肝体积,并进行了移植手术技术改进。结果 58例供者共摘取55例右半供肝及3例左半供肝。右半供肝均不含肝中静脉,重量为400～860 g(中位数550 g),右半供肝与受者标准肝重比为31.7%～71.7%(中位数45.4%),供者残肝体积均大于全肝体积的35%。58例供者发生并发症7例(12.5%),无死亡,术后住院时间7～30 d(中位数11 d)。术后对56例受者随访2～52个月(中位数11个月),发生并发症15例(26.8%),死亡4例(7.2%)。1年实际生存率92.8%。结论采用不包含肝中静脉的右半供肝,术前 CT 测量残肝体积>35%,同时右半供肝与受者标准肝重比>40%者进行右半肝移植可保证供受者安全,反之则应考虑采用双供肝肝移植。

Objective To investigate the ways to ensure the safety of donors and recipients in adult- to-adult living donor liver transplantation （A-ALDLT）. Methods From January 2002 to September 2006, 56 A-ALDLT were performed in our division, including 52 cases of right lobe graft were obtained without medial hepatic vein（MHV） and 4 cases of dual grafts （ 1 case using two left lobes, 3 cases using 1 right and 1 left lobe）. The most common diagnoses were hepatitis B liver cirrhosis （62. 5% ） and hepatocellular carcinoma （30. 4% ） in recipients. Among them, 10 cases scored more than 25 with the model of end-stage liver disease （MELD） scoring system. Triphasic liver computed tomography were used for reconstruction of hepatic vessels and to calculate total liver and right liver volumes in donors. Various innovative surgical techniques were adopted too. Results From the 58 living donors, 55 right lobes and 3 left lobes were obtained. The 55 right lobe grafts were obtained without medial hepatic vein, weighed 400 ~ 860 g （ median 550 g）. The ratio of graft volume to recipient standard liver volume ranged from 31.7% to 71.7% （ median 45.4% ）. All donors＇ remnant liver volumes were over 35% of the total liver volume. There was no donor mortality, but 7（ 12.5% ） donors experienced complications. Of the 56 recipients, with a follow-up period of 2 ~52 months （median 11 months）, 15 （26. 8% ） developed complications and 4（7. 2% ） died within 3 months post operation. The 1-year actual survival rate was 92. 8%. Conclusions When preoperative CT volume shows remnant liver volume is greater than 35% of the total liver volume, and graft volume to recipient＇s standard liver volume ratio is over 40%, A-ALDLT using right lobe graft is a safe procedure for beth donors and recipients, otherwise the dual graft liver transplantation should be considered.