血缘性活体肝部分移植治疗先天性胆道闭锁

Living Related Liver Transplantation for Biliary Atresia

目的:探讨活体肝移植治疗儿童先天性胆道闭锁的临床体会。方法:受者为14个月男童,诊断为先天性胆道闭锁症,供者为患儿的父亲,术中切取供者肝脏的左外侧叶,原位移植给患儿。结果:供肝左外侧叶切取手术历时485min,术中出血200mL,无输血,切取肝脏265g,供者术后5d肝功能恢复正常。受者手术历时420min,术中失血400mL,肝脏冷缺血时间30min,无肝期60min,采用改良背驮式肝移植,术中使用IL-2R拮抗剂免疫诱导治疗,术后FK506、骁悉及甲基强的松龙(甲强龙)免疫抑制治疗,术后1个月各项生化指标正常,随访9个月,生长发育正常,无外科并发症。结论:活体肝部分移植应确保供者的安全,充分评估供、受者术前情况,术中良好的肝外科、血管外科技术及围手术期管理是确保活体肝移植术成功的关键。

Objective： To summarize the clinical experience of living related hver transplantation for biliary atresia. Methods： The recipient was a 14 month old boy with congenital biliary atresia. The left external lobe of the liver （segment Ⅰ-Ⅰ,Ⅲ） from the patient＇s father was excised and was orthotopically transplanted to the child. Results： The resection of left external lobe（265 g） of liver from donor took 485 minutes. The blood loss was 200 mL, no blood infusion. The operating time of graft implantation was 420 minutes. The blood loss was 400 mL. Non-liver stage was 60 minutes. The cold ischemic time was 30 minutes. FK506, mycophenolate mofetil （MMF）and prednisone were used for postoperative immunosuppression. The biochemical parameters of the child became normal in 1 month and had no surgical complication. Conclusion： The living related liver transplantation is a complex operation. Perfect operative technique in hepatic and vascular surgery and postoperative intensive care are the keys to ensure the success of the procedure.