成人右半肝移植物切取体会——附51例临床分析

Experience of donor selection and right lobe hepatectomy in adult-to-adult living donor liver transplantation—51 cases clinical analysis

目的总结成人间右半肝活体肝移植供体选择及右半肝切除经验。方法自1996年5月至2000年9月共行成人间右半肝活体肝移植5l例。供体的选择与评价包括:实验室检查、影像学检查和心理状况评价。供体右半肝切除采用我们设计的方法进行。结果供体平均手术时间和失血量分别为10.2h 和602ml,平均住 ICU 及住院天数分别为2.4 d和12d。无手术死亡。共有16例发生手术后并发症,它们包括:伤口感染、泌尿道感染、胆道狭窄、淤胆、膈下积液、肠梗阻、切口疝等。所有供体恢复良好,均已回到原来的工作位置。结论只要严格选择供体并熟练掌握供体肝切除技术,则成人右半肝活体肝移植供体手术是安全的。

Objective To summarize the experience of donor selection and right lobe hepatectomy in adult-to-adult living donor liver transplantation.Method From May 1996 to September 2000,51 live donor liver transplantations using right lobe grafts were performed at Queen Mary Hospital,Hang Kong.All donors received psychological counseling before the donor operations.They were screened by laboratory tests including complete blood cell count,liver and renal biochemistry values,and viral serologic studies.Computed tomography(CT),CT volumetry,and hepatic arteriography were routinely performed.All donors underwent surgery using the method we designed.Results The median duration and blood loss of operation were 10.2 h and 602 ml,respectively.The median ICU stay and hospital stay were 2.4 and 12 days,respectively.There was no donor mortality.The compli- cations of donor operation included wound infection,urinary tract infection,biliary stricture,subphrenic collec- tion,bowel obstruction,incision hernia,etc.All donors well recovered and have returned to their previous occu- pation.Conclusion The live donation of fight lobe graft for adult-to-adult liver transplantation is safe provided that donor selection is strict and utmost care is exercised during the operation.