血管重建技术在预防活体肝移植小移植肝综合征中的地位

Role of vascular reconstruction in the prevention of small-for-size syndrome after living donor liver transplantation

目的:从外科技术角度探讨活体肝移植后小移植肝综合征的防治。方法:回顾性分析本组2002年9月至2008年10月完成的59例活体肝移植临床资料,其中移植物重量/受体体重(graft-recipient weight ratio,GRWR)≤0.8%者共4例,评估为小移植肝。采用血管成型、血管架桥方法保证"宽敞"的流出道,综合显微外科、血管搭桥及动脉成形等相关技术行肝动脉重建。结果:4例小移植供肝受体中仅1例发生小移植肝综合征,经药物治疗后,移植肝肝功能逐步好转,4周后痊愈。随访17～90个月,均获长期存活,生活如常人。结论:小移植肝综合征重在预防。在充分保证供体安全的前提下,尽量获取较多肝容量,重建足够"宽敞"的流出道,保证门静脉和肝动脉重建质量,是预防小移植肝综合征发生最重要的措施。

Objective：To investigate some surgical problems about the prevention and treatment of small-for-size syndrome after living donor liver transplantation （LDLT）.Methods：LDLT was performed in 59 cases from February 2002 to October 2008.The clinical data were analyzed retrospectively.Four cases whose graft-recipient weight ratio （GRWR）were≤0.8%,were evaluated as small-for-size graft.Angioplasty and vascular graft provide unobstructed outflow,microsurgery,vascular graft and artery plasty were applied in hepatic artery reconstruction.Results：One case was diagnosed as small-for-size syndrome only and recovered four weeks later with suitable drug treatment.Recipients were followed up for 17 to 90 months with no death.Conclusion：On the premise of donor＇s safety,much liver graft procurement,a large outflow,high-quality reconstruction of hepatic artery and portal vein are the key points to prevent the incidence of small-for-size syndrome.