儿童器官捐献供肝行劈离式肝移植的肝动脉分割与重建

Hepatic arterial segmentation and reconstruction during split liver transplantation using pediatric deceased donor

目的探讨儿童器官捐献供肝行劈离式肝移植时肝动脉分割与重建的临床技术要点.方法回顾性分析中山大学附属第三医院肝脏移植中心自2017年7月至2019年3月完成的15例儿童器官捐献供肝施行的劈离式肝移植的临床资料.15例儿童供者年龄4.6~16.3岁.脑死亡器官捐献供者13例,心脏死亡器官捐献供者2例.共施行了30例劈离式肝移植,劈离方式为右三叶+左外叶劈离13例,减体积右三叶+左外叶劈离1例,完全左半+右半肝劈离1例.受者为成人+儿童者5例,双儿童受者10例.供肝肝动脉M ichels分型Ⅰ型13例、Ⅴ型1例、Ⅵ型1例.分割方式中I型将肝固有动脉保留于右三叶肝的有8例,5例低年龄(<7岁)供肝中有4例则将肝固有动脉保留于左肝,肝动脉重建方式本组<4岁的受者儿童的肝动脉重建均在4.5倍放大镜下采用8-0 Prolene线,"两点或三点法"间断吻合.结果 15例儿童供肝均顺利完成肝动脉分割和重建,5例成人受者无肝动脉狭窄和血栓形成发生.25例儿童受者有2例术后出现肝动脉血栓形成.总的肝动脉并发症为6.67%.结论儿童供肝应根据供肝大小和肝动脉分型特点采取动脉分割和重建方式,减少动脉并发症的发生.

Objective To explore the clinical and technical essentials of hepatic arterial segmentation and reconstruction during split liver transplantation using pediatric deceased donor .Methods The clinical data were retrospectively analyzed for 15 pediatric deceased donor aged 4 .6-16 .3 years undergoing split liver transplantation from July 2017 to March 2019 .The donors were DBD (donation after brain death ,n=13) and DCD(donor after cardiac death ,n=2).Thirty split liver transplantations were performed using these 15 pediatric deceased donors .The receptors were adult + child (n=5) and child + child recipients (n=10). According to the Michels' classification ,the clinical types were I (n= 13),V (n= 1) and VI (n= 1). Hepatic arterial segmentation :In type I hepatic arterial type donor liver ,proper hepatic artery was retained in right trilobar liver (n=8),low-age (< 7 years) donor liver (n=5),retaining proper hepatic artery in left liver & reconstructing right trilobe directly using right hepatic artery trunk (n= 4).Methods of hepatic artery reconstruction :8-0 Prolene string was utilized under 4 .5 times magnifying glass for reconstructing hepatic artery in recipients aged under 4 years .Results Hepatic arterial segmentation and reconstruction were successfully completed .Hepatic arterial thrombosis occurred in 2 ./25 ecipients .The overall incidence of hepatic arterial complications was 6 .67%.Conclusions For reducing the occurrence of arterial complications , arterial segmentation and reconstruction in pediatric deceased donor should be performed according to the size of donor liver and the characteristics of hepatic arterial classification .