成人间活体肝移植供肝的后台准备

Backtable procedures of the grafts in adult-to-adult living donor liver transplantation

目的 探讨成人活体肝移植供肝的灌注和管道重建的技术。方法 回顾性分析41例成人活体肝移植供肝的后台处理临床资料。结果 41个供肝，均为不包括肝中静脉的右半肝，供者男9例，女32例，年龄19～65岁。供肝切取后经门静脉灌注HTK液2～3L（平均2.45L）。只有一支门静脉右支者35例，右前支＋右后支门静脉6例。右肝管29例，右前叶肝管＋右后叶肝管10例，右后叶肝管＋右前上段支＋右前下段支2例。肝静脉：右肝下静脉＋V_5/V_814例，只有一支右肝静脉15例，2支肝中静脉分支8例，4例有3支肝中静脉分支。肝中静脉分支直径〉0.5cm者均重建，重建V_5/V_8和右肝下静脉28例次（70.0%），右前叶肝管和右后叶肝管整形6例（14.6%），右后叶肝管和右前叶下段肝管整形3例（7.3%），门静脉整形2例（4.8%），门静脉搭桥4例（9.7%）。结论 成人活体肝移植的供肝后台处理与尸体肝移植有明显的不同，其断面的管道处理直接影响移植肝的存活和预后。

Objective To review backtable graft perfusion and the reconstruction of portal vein （PV）, bile duct, hepatic vein（HV） in adult-to-adult living donor liver transplantation （AALDLT）. Method Data of 41 AALDLT grafts were analyzed retrospectively. Results There were forty-one right hepatic grafts, without inclusion of middle hepatic veins, Donors were males in 9, and females in 32, age between 19 and 65 years. Harvested grafts were perfused with HTK solution of 2 to 3 litres. Right portal vein （RPV） was reconstructed in 35 grafts, right anterior branch and right posterior branch of PV were reconstructed in 6 grafts. Right bile duct were kept in 29 grafts. Right anterior ＋ right posterior branches of bile duct in 10 grafts. Right posterior branch ＋ right superior segment branch ＋ right inferior segment branch were left over in 2 grafts. 28 grafts were with right inferior HV ＋ V5/V8 HV, 15 grafts with one branch of HV, 8 with two branches of HV, 4 with three branches. HVs in V5/V8 ＋ right inferior segment branch were reconstructed in 28 cases （70. 0% ）. Right anterior ＋ right posterior branches of bile duct were reconstructed in 6 cases. PV was reconstructed in 2 cases （4. 8% ）, and reconstructed by interposition vessel in 4 cases （9. 7% ）. Conclusion The backtable procedures of the grafts in AALDLT is different from that of cadaveric liver transplantation.