儿童肝移植的手术技术革新

Surgical technical innovations in pediatric liver transplantation

近十年来,随着手术技术与术后管理水平的提高,儿童肝移植在我国发展迅速,其规模已经由国内少数几家肝移植中心扩展到十余个省市、自治区,单年度手术量连续3年突破1000例,跃居世界第1位,儿童肝移植手术技术也逐渐向精准医疗发展。儿童肝移植手术技术的发展主要以“移植物”为中心展开,本文从扩大供肝来源的劈离式肝移植、辅助性肝移植、多米诺肝移植和超减体积肝移植,以及以腹腔镜与达芬奇手术系统为代表的微创外科技术、显微外科吻合技术在儿童肝移植中的应用等方面出发,评述儿童肝移植手术技术的发展特点与趋势,为进一步提高移植物远期生存率与受者生存质量提供参考。

In recent decade,pediatric liver transplantation has developed rapidly in China due to the improvement of surgical techniques and postoperative management,which has been applied from several domestic liver transplantation centers to more than 10 provinces,cities and autonomous regions.The annual quantity of pediatric liver transplantation has exceeded 1000 for 3 consecutive years,ranking first across the world.The technique of pediatric liver transplantation has been gradually oriented to precision medicine.The development of pediatric liver transplantation mainly focuses on the"grafts".In this article,the development characteristics and trends of pediatric liver transplantation were elucidated from the perspectives of different types of liver transplantation that expanded the source of donor liver,including split liver transplantation,auxiliary liver transplantation,Domino liver transplantation and liver transplantation with hyper-reduced grafts,as well as the application of minimally invasive surgical and microsurgical anastomosis techniques in pediatric liver transplantation,which represented by laparoscopic surgery and Da Vinci surgical system,aiming to provide reference for further improving the long-term survival rate of grafts and the quality of life of the recipients.