成人间活体供肝移植中供肝的肝中静脉分配

Middle hepatic vein management in adult-to-adult living donor hepatectomy

目的探讨成人间活体供肝移植中切取供者右半供肝（含或不含肝中静脉）的安全性及临床效果。方法2007年6月至2008年9月，单小组实施成人间活体供肝切取手术78例；76例行右半供肝移植，其中供肝含肝中静脉30例（含肝中静脉组）．不含肝中静脉46例（不含肝中静脉组）。对两组供者的基本资料、手术相关资料以及术后肝功能恢复情况进行了评估和比较。结果CT计算供者残留肝脏体积比为29．40％～50．99％；供肝重量与受者体重的比例（GRWR）为0．74％～1．76％。两组供者（含与不含肝中静脉组）在年龄、体重身高指数（BMI）、手术时间、术中失血量和输注红细胞量、拔除引流管时间、住院时间以及供者存活率方面比较，差异均无统计学意义；含肝中静脉组供者体重小于受者体重所占的比例（75．0％）明显高于不含肝中静脉组（40．0％），差异有统计学意义（P〈0．05）；含肝中静脉组切取的供肝重量、实际GRWR以及供肝冷保存时间明显低于不含肝中静脉组（P〈0．05）；两组供者术后肝功能恢复情况比较，差异无统计学意义。结论供者经过严格的术前评估，切取含或不含肝中静脉的右半供肝均是安全的，临床效果满意。

Objective To evaluate the donor safety and clinical outcomes in adult-to-adult living donor hepatectomy with or without middle hepatic vein. Methods From June 2007 to September 2008, 78 consecutive cases of living donor hepatectomy were performed by the same surgical team. Seventy- six candidates donated their right lobe liver after thorough donor assessment and precise evaluation of blood vascular and biliary anatomy, and their middle hepatic vein was harvested. Donor demographic data,operative data and liver function after operation were compared. Results Donor remnant liver volume to total liver volume ratio which was calculated by computed tomography was 29. 40 % 50. 99 %,and graft weight to recipient body weight ratio was between 0. 74 to 1.76. There was no significant difference in donor age, body mass index, operative time, blood loss and transfusion volume, abdominal drainage time and donor recipient survival rate between the middle hepatic vein-harvested group and non-middle hepatic vein-harvested group, and also the peak value of ALT, AST, T-bilirubin and D-bilirubin after operation. There was significant difference in graft weight,actual graft weight to recipient body weight ratio, graft cold preservation time, and the percentage of cases in which the donors body weight was lower than the recipienrs between the middle hepatic vein-harvested group and non-middle hepatic vein-harvested group. Conclusion It was safe to perform right lobe living donor hepatectomy with or without middle hepatic vein after thorough donor assessment and precise evaluation, and the clinical outcome was satisfactory.