活体右半肝移植肝中静脉取舍选择与供受者的安全性

Middle hepatic vein treatment algorithm in right lobe living donor liver transplantation for donor recipient safety

目的根据术前CT评估供体残余肝脏比例（RLV％）和评估移植物重量与受者体重比（GRWR），参考肝中静脉解剖情况等因素制定术前肝中静脉（MHV）切取分配方案，研究这种分配方案对活体肝移植供、受体安全的影响，并为今后临床工作提供参考。方法同一外科小组连续73例活体右半肝肝移植病例按术前肝中静脉分配方案，切取肝中静脉28例，不切取肝中静脉45例。对供受者性别、年龄、体重、手术时间及失血量等基本资料，移植物重量、无肝期、供肝冷保存时间、围术期供受者存活率、小肝综合征发生率以及供受者术后肝功能恢复情况等移植物相关资料进行比较。结果两组供者术中均未输注血制品，术后均无死亡及小肝综合征发生病例。1例受体术后6d出现移植肝急性肝坏死转尸体肝移植后痊愈，1例发生小肝综合征保守治疗后痊愈，受者围手术期死亡1例（术后30d），死亡原因为全身播散性感染并发呼吸功能衰竭—旦肝功能已恢复正常。切取MHV组与不切取MHV组之间受者年龄、供体体重小于受体病例所占比例、实际GRWR、移植物重量、移植物冷保存时间、受体术后ALT最高值间差异有统计学意义。结论这种以术前CT评估供者残肝比例和评估GRWR为分类标准，重点参考MHV解剖因素的MHV取舍方案对供、受者均是安全的。

Objective The treatment algorithm of donor middle hepatic vein （MHV） was made depending on the remnant liver volume of the total donor liver volume as calculated by computer tomography, estimated graft-to-recipient weight ratio and also MHV anatomy. The present study was to analyze the influence of this algorithm upon the safety of donors and recipients in right lobe living donor liver transplantation （LDLT） and to provide references for our future clinical practices. Methods Data of 73 consecutive LDLT cases, operated and managed by the same surgical team according to the pre-operation MHV treatment algorithm, were analyzed. MHV was harvested in 28 cases and not in 45 cases. Donor and recipient gender, age, weight, operation time, blood loss volume, graft weight, non-hepatic phase, graft cold preservation time, perioperative survival rate and the incidence of small-for-size syndrome were compared, and also the peak post-operative values of ALT, AST, T-bilirubin and D-bilirubin. Results No donor needed blood transfusion and suffered small-for-size syndrome. One recipient recovered from small-forsize syndrome successfully by medical interventions. One recipient had acute hepatic necrosis at Day 6 postoperation and was converted into cadaveric liver transplantation. At Day 30 post-operation, one recipient died from disseminated infections and respiratory failure, but his liver function was normal. There was significant difference in donor and recipient age, actual GRWR, graft weight, graft cold preservation time and recipient＇ s ALT peak value between the MHV harvest group and the MHV non-harvest group. Conclusion The MHV treatment algorithm is safe to both donors and recipients.