成人间左半肝移植九例报告

Adult liver transplantation using left lobe： a report of 9 cases

目的观察成人左半肝移植的临床效果，并探讨其可行性。方法回顾性分析2007年3月至2011年4月间9例成人左半肝移植的临床资料，其中5例为尸体供肝劈离式肝移植，4例为活体左半供肝移植。9例供肝的重量平均为444．6g（325～570g），移植物重量与受者体重比平均为0．886％（0．65％～1．18％），其中7例包含肝中静脉。6例采用背驮术式，3例采用经典术式。有4例受者因术中门静脉压超过20mmHg（2．67kPa），其中3例结扎了脾动脉，1例接受了脾切除术。术后所有受者均常规使用他克莫司＋吗替麦考酚酯＋皮质激素的三联免疫抑制方案。术后对受者进行长期随访，观察血管并发症和胆管并发症的发生情况及受者肝功能恢复状况和存活情况。结果4例活体供者切取左半肝后均未发生严重并发症，肝功能恢复良好。9例受者术后平均随访时间为15．7个月（1～51个月），移植物和受者术后1年存活率均为77．8％（7／9）。术后有2例受者死亡，其余7例中1例发生肝功能恢复延迟，6例移植肝功能恢复顺利。术后发生胆管吻合口狭窄1例，小肝综合征1例，门静脉血栓形成1例，肝功能恢复延迟1例，以及腹腔感染2例。结论在严格选择供、受者的前提下，成人左半肝移植是安全、可行的，且效果良好。

Objective To investigate clinical effectiveness and feasibility of adult liver transplantation using the left lobe. Methods We analyzed the clinical data of 9 recipients who underwent adult liver transplantation using left lobe from March 2007 to April 2011, including 5 cases receiving split liver transplantation and rest 4 cases receiving living donor liver transplantation. Mean graft weight was 444. 6 g （325-570 g） and mean graft-recipient weight ratio was 0. 886% （0. 65%-1.18%）. The middle hepatic vein was reserved in 7 cases. Six cases underwent Laden back surgical and 3 cases underwent classical surgical procedures, During the operation, PVP of 4 cases exceeded 20 mm Hg （2. 67 kPa）, 3 cases were subjected to splenic artery ligation and 1 case to splenectomy. All recipients after operation were treated with triple drug maintenance therapy of Tacrolimus, Mycophenolate Mofetil and corticosteroids. We followed-up the recipients long-term, and the incidence of vascular complications and biliary complications, patient and graft survival, restoration of liver function were observed. Results No serious complications occurred in 4 living donors subject to left lobotomy and the liver function had a good recovery. The median follow-up period of these 9 recipients was 15. 7 months （1 month to 51 months）. Overall 1-year patient and graft survival rate was 77. 8% （7/9）. Two cases died after operation. In the remaining 7 cases, 1 case had initial poor graft function, and cases bad initial good graft function. The main complications after operation included biliary anastomotic strictures in l case, small-for-size syndrome in 1 case, portal vein thrombosis in 1 case, initial poor graft function in 1 case and abdominal infection in 2 cases. Conclusion With strict for selecting and good matching donor-recipient, adult liver transplantation using left lobe is safe and feasible.