活体肝移植供体手术及术后管理(附22例临床分析)

Clinical analysis of donor hepatectomy and postoperative management in 22 cases of living donor liver transplantation

目的探讨提高活体肝移植供体手术安全性和加强术后管理的措施。方法回顾性分析北京大学人民医院2003年2月至2009年6月22例活体肝移植供体的临床资料,总结供体术前评估、手术技术、术后并发症及随访情况。结果术前对供体进行三步法评估,术中采用超吸刀(CUSA)进行肝脏实质分离,术后定期随访。供肝移植物包括肝左外叶2例、左半肝6例、扩大左半肝1例、右半肝5例和扩大右半肝8例。1例在术后早期出现腹腔内出血,1例合并胸水,1例枕后皮下血肿,其他供体未出现严重并发症,术后肝功能迅速恢复正常,随访至今无供体死亡。结论活体肝移植供体手术复杂,严格术前评估,术中精细操作,术后加强随访是提高活体肝移植供体安全的重要保证。

Objective To improve the safety of donor surgery and enhance the postoperative management of liver donors in living donor liver transplantation （LDLT）. Methods The clinical data was retrospectively analyzed in 22 cases of LDLT donnor surgery were performed from February 2003 to June 2009 in Peking University People＇ s Hospital, preoperative evaluation, surgical technigue, postoperative complications and outcome were retrospectively analyzed. Results Three steps of preoperative evaluation were used, Ultrasonic Dissector （CUSA） was applied in donor hepatectomy and all of the donors were followed up after operation. Totally, 2 left lateral hepatic lobes, 6 cases of left hepatic lobes, 1 extended left hepatic lobe, 5 right hepatic lobes and 8 cases of extended right hepatic lobes were harvested. No complication except 1 case of intra-abdominal bleeding, 1 case of hydrothorax and 1 case of eechymoma was found. Hepatic function restored to normal soon and no death occured. Conclusion Strict preoperative evaluation, precise surgical technique and routine follow up are guarantees of donor safety in LDLT.