辅助性原位活体肝部分移植一例报告

Living-related auxiliary orthotopic partial liver transplantation: report of a case

目的探讨应用辅助性原位活体肝部分移植治疗Willson′s病的可行性。方法受体女性 ,2 0岁 ,O型血 ,因肝豆状核变性而接受辅助性原位活体肝部分移植。供体男性 ,2 1岁 ,A型血。手术切除受体病肝左外叶 2 6 0g ,取供体左外叶肝脏 2 95g原位移植于受体。因供受体血型不同 ,术前行血浆置换 ,术后以FK5 0 6、激素、环磷酰胺联合免疫抑制治疗。结果受体术后 15d出现肝动脉血塞形成 ,予以溶栓治疗后出现腹腔内出血 ,术后 17d开腹止血 ,清除血肿 ,术后发生腹水 ,肺不张 ,胆瘘等 ,均治愈。至今患者已生存 1年 3个月 ,并恢复正常生活 ,铜蓝蛋白水平正常。移植肝脏体积明显增大 ,手足震颤明显减轻。

ObjectiveTo investigate the feasibility of auxiliary orthotopic partial liver transplantation (APOLT) from a living donor for the treatment of Willson′s disease.MethodsThe patient was a 20-year-old girl with Willson′s disease, whose blood type was O. The donor was a man aged 21 and his blood type was A. The left lateral lobe (260?g) of patient′s liver was removed, the left lateral lobe (295?g) of donor′s liver was grafted to the patient in situ. Blood plasma exchange was carried out to the recipient before transplantation. FK506 adrenocortical hormones and cytoxan was administered after operation. ResultsThe recipient had a onset of hepatic artery thrombosis 15 days after operation, and ensuing intraabdominal hemorrhage caused by thrombolytic agent was successfully managed by laparotomy. Other postoperative complications such as hydroperitonia, pulmonary atelectasis and bile fistula were cured. Now the patient has survived 15 months with a normal copper-protein level, a mitigated extrapyramidal symptom and the grafted liver grows larger.ConclusionAPOLT is a feasible remedy for late-staged Willson′s disease.