原位劈离式供肝儿童肝移植经验总结

In-situ split liver transplantation for pediatric recipient: a single-center experience

目的探讨原位劈离式供肝儿童肝移植的手术技术及临床疗效。方法回顾性分析2015年6月至2018年8月间开展的10例脑死亡器官捐献原位劈离式供肝儿童肝移植的临床资料。供者均为男性,年龄18~48岁,中位年龄28.5岁。劈离式左半肝供肝1例,左外叶供肝9例(2例减体积)。4例供肝在我院手术,其余6例供肝分配到另外2家移植中心。受者原发病8例为胆道闭锁(6例葛西术后),1例肝小静脉阻塞综合征,1例Alagille综合征。年龄7个月~11岁,中位年龄10个月,体重(9.8±6.6)kg(5~28 kg)。结果供肝均采用在体原位劈离,供者劈离手术时间(88.5±18.9)min,供肝重量(336.7±85.4)g。受者均采用背驮式肝移植手术方式,受者手术时间(542.5±112.1)min,无肝期(52.0±13.5)min。供肝重量与受者体重比(GRWR)(3.98±0.96)%,2例左外叶供肝GRWR超过5%,切除部分Ⅲ段肝脏,用减体积左外叶供肝。10例受者随访至今,最长随访3年5个月。9例存活,1例术后1 d死于心肺功能衰竭。结论原位劈离式供肝儿童肝移植效果良好,可增加儿童供肝来源。

Objective To evaluate the efficacy of in-situ split liver transplantation (ISSLT) in children. Methods From June 2015 to August 2018, 10 liver grafts from DBD were split in-situ. All the donors were male, and the median age of the donors was 28.5 year old (18-48 year). One left half graft and 9 left lateral lobe grafts (including 2 reduced size grafts) were transplanted to 10 pediatric recipients. Four grafts were transplanted in our center, and the rest 6 grafts were shared to other two transplant center. The primary diseases of the recipients included biliary atresia (8/10), hepatic sinus obstruction syndrome (1/10) and Alagille syndrome (1/10). The median age of the recipients was 10 month (7 month-11 year), and the mean body weight was 9.8±6.6 kg (5-28 kg). Results All liver grafts were split in-situ. The mean split time of liver grafts was 88.5±18.9 min. The mean weight of split grafts was 336.7±85.4 g. All recipients were subjected to piggyback liver transplantation. Operation time was 542.5±112.1 min. Anhepatic time was 52.0±13.5 min. GRWR was (3.98±0.96)%. GRWR of two cases was more than 5%, so segment Ⅲ was partially reduced. During the follow-up period, 9 cases were alive and 1 case died due to multiple organ failure 1 day after liver transplantation. Conclusions ISSLT can enlarge the graft pool for children and achieve good results.