亲属成人间活体肝移植1例临床分析

One case report of living donor liver transplantation between adult relatives

背景:活体肝移植的开展扩大了供体来源,有效缓解了供肝匮乏的局面,且活体供肝冷缺血时间短、质量好;若供、受者为亲属,可能具有免疫相容的优势。目的:总结1例亲属成人间活体肝移植的临床体会,探讨成人间活体肝移植治疗终末期肝病的手术方式及移植效果。方法:乙型肝炎后肝硬化(失代偿期)并门脉高压症患者1例,女性,年龄54岁,拟行肝移植手术。供者为患者外甥,23岁,既往身体健康。经术前评估后,切取供者右半肝并原位移植给受者。术后常规给予免疫抑制、防治感染、护肝、支持等治疗。结果与结论:术后供者生命体征平稳,手术历时4h,失血约150mL,术后第5天肝功能基本恢复正常,术后10d行上腹部CT平扫加增强提示符合活体肝移植供体右半肝切除术后改变。术后受者生命体征平稳,手术历时7h,失血约500mL,彩超检查移植肝血管通畅,血供良好;生化指标逐渐恢复至正常范围,提示移植肝功能情况良好。术后供、受者无严重并发症发生,均健康存活,门诊随访肝功能正常。结果说明成人间活体肝移植为术前周密的准备工作,选择最佳的移植手术时机以及手术的成功创造了最佳条件,是在尸体供肝短缺的情况下治疗终末期肝病的理想方法。

BACKGROUND： Living donor liver transplantation expands the source of donor, relieves the situation of donor liver shortage, and its cold ischemia time is short and quality is good. If the donor and recipient are relatives, it maybe have the merit of immunity interconsistency. OBJECTIVE： To summarize the clinical experiences of living donor liver transplantation （LDLT） between adult relatives, to explore the operation mode and transplantation effects of living donor liver transplantation between adult relatives for the treatment of end-stage liver disease. METHODS： The recipient was a 54-year-old woman who had been diagnosing post-hepatitis B cirrhosis （decompensation stage） combine portal hypertension. The donor was the patient’s nephew, who was a 23-year-old man. After surgery evaluation, procurement right lobe and transplantation to recipient, the operation was orthotopic liver transplantation. After the surgery, patient was given immunosuppression prevention of infection, hepatic protection, and other relevant supports, etc. RESULTS AND CONCLUSION： After surgery the donor had stable life signs, the operative duration for liver procurement was 4 hours, blood loss was about 150 mL, and liver function recovered to normal in 5 days postoperatively. Then he was performed upper abdominal CT scans and enhanced scans that suggested the liver coincided the changes which had been taken the right lobe in living donor transplantation. The recipient’s life sign was stationary, the surgery for live transplantation lasted 7 hours, and blood loss was about 500 mL. Color ultrasonic scan showed that liver vessels were patency, blood supply was satisfactory, and biochemical indexes recovered to normal gradually, which meant the transplantation liver function well. They survived without various complications, the follow-up survey that the function of liver retained normal in outpatient department. The case suggested that adult-to-adult living donor liver transplantation （A-A LDLT） was an excellent way to help tackle the problem of cadaveric liver shortage for treating end-stage liver disease.