单独Ⅱ段供肝在儿童亲属活体肝移植中的应用五例

Application and analysis of segment 2 monosegment graft in pediatric living donor liver transplantation

目的探讨使用单独Ⅱ段供肝作为移植物对儿童受者进行活体肝移植的临床特点及价值。方法收集2015年3月至今完成的5例以单独Ⅱ段供肝为移植物的儿童肝移植的临床资料，包括受者体重；术前评估的供者左外侧叶及单独Ⅱ段供肝移植物受者重量比（GRWR）；术中实测的左外侧叶及单独Ⅱ段供肝GRWR；术中是否存在关腹困难，术后受者肝功能恢复情况，术后是否出现大肝综合征等。分析单独Ⅱ段供肝移植的特点和对受者预后的影响。结果5例使用单独Ⅱ段移植物的受者中位体重为6．5kg（4．6～8．0kg），术前评估的供者左外侧叶及单独Ⅱ段供肝的GRWR中位值分别为5．74％（4．16％～7．30％）和2．90％（2．50％～3．95％）；术中实测的单独Ⅱ段供肝的GRWR中位值为2．92％（2．4％～3．3％）。5例受者术中均无关腹困难，术后患者肝功能恢复顺利，无血管并发症，无明显的大肝综合征表现。1例于术后18d出现迟发性胆漏，经腹腔穿刺引流后治愈。结论对于小体重的儿童活体肝移植受者，单独Ⅱ段移植物可以作为避免大肝综合征的一种选择。

Objective To analyze the values and characteristics of segment 2 monosegment graft in living donor liver transplantation for pediatric recipients. Method The clinical data of 5 recipients and donors who were given living donor liver transplantation with segment 2 monosegment graft between Mar. 2015 to Jan. 2016 in our institution were collected, including weight of recipients, estimated and actual graft to recipient weight ratio （GRWR） of left lateral segment （LLS） and segment 2 （$2）, primary abdominal closure or not, recovery of recipient liver function after the operation, and the signs of large for size syndrome or not. The characteristics of segment 2 monosegment graft in living donor liver transplantation for pediatric recipient and influence on recipient prognosis were analyzed. Result The median weight of recipients was 6. 5 kg （4. 6-8. 0 kg）, median estimate GRWR of LLS and S2 before operation was 5.74% （4. 16%-7. 30%） and 2.90% （2. 50%-3.95%） respectively, and median actual GRWR of S2 was 2. 92% （2. 4%-3.3%） during the operation. All the 5 recipients achieved primary abdomen closure and their liver function recovered uneventfully without any signs of large for size syndrome and complications of vessels. Delayed bile leakage occurred in 1 recipient 18 days after operation and cured by percutaneous drainage. Conclusion Segment 2 monosegment is a graft type, which can be chosen to avoid large for size syndrome in pediatric living donor liver transplantation especially for low weight infantal recipients.