活体右半肝供肝切取的经验

Experience of Right Lobe Hepatectomy in Living Donor Liver Transplantation

目的对活体右半肝供肝切取手术经验进行总结。方法回顾性分析我中心单一外科小组2007年8月至2008年12月期间连续实施右半肝切取的76例供者资料。术前综合考虑移植物大小、残肝比例、有无脂肪肝、肝中静脉类型及受体术前门静脉高压情况,以确定是否带肝中静脉。术中以缺血线确定肝切平面,以术中B超了解肝中静脉的走向及分支,肝切线在肝中静脉左或右侧紧贴肝中静脉。行术中胆道造影,了解胆道结构及变异。记录手术时间,术中失血量,术后住院时间,术后住院期间总胆红素、国际标准化比值(INR)和ALT水平变化情况以及术后各种并发症发生情况。结果 76例供体均顺利完成手术,手术时间(8.3±1.3)h,术中失血量(325±127)ml,术中均未输血。总胆红素、INR和ALT水平于术后第12天恢复正常。本组供体术后住院期间最常见并发症是伤口感染(共5例),胆汁郁积4例,断面漏胆4例;11例患者于术后4～7d出现不同程度的胃排空障碍;均经相应处理后好转。术后住院9～21d,中位时间14d。结论充分的术前评估以及精准的术中操作能够保证供肝的顺利切取并有利于供体的术后恢复。

Objective To report our experience in living donor liver harvesting of right lobe grafts.MethodsThe data of 76 living donors of right lobe grafts hepatectomy between August 2007 and December 2008 were studied.Before operation,the graft size,remnant liver volume rate,fatty liver,middle hepatic vein type,and the level of portal hypertension of recipient were comprehensive assessed to determine whether harvested middle hepatic vein.The graft was harvested depending on the port vein and hepatic artery ischemia-line.B-ultrasound was used to definite the structure and branch of middle hepatic vein,and intraoperative cholangiography was performed to definite the structure and variation of bile duct.Donor operative time,intraoperative blood loss,postoperative hospital stay,levels of bilirubin,international normalized ratio（INR）,and ALT,and complications after operation were recorded.Results All the operations were successful.The operative time was（8.3±1.3）h,the blood loss was（325±127）ml without blood transfusion in operation.The ALT,INR,and bilirubin recovered on the 12th day.The most common complication in early post-operation was wound infection in 5 cases,4 cases had cholestasis,4 cases occurred cross-section bile leakage,and 11 cases occurred varying degrees of delayed gastric emptying in 4～7 d after operation,who were all alleviated by corresponding treatments.The hospital stay was 9～21 d（median：14 d）after operation.Conclusion Preoperative evaluation of the hepatic anatomy and precise surgical procedure are crucial,which will help the development of graft harvesting and rehabilitation of donor.