单孔腹腔镜肝左外叶供肝获取术在小儿活体肝移植中的应用价值

Application value of single-port laparoscopic left lateral donor liver acquisition in pediatric living donor liver transplantation

目的探讨单孔腹腔镜肝左外叶供肝获取术在小儿活体肝移植中的应用价值。方法采用回顾性描述性研究方法。收集2020年1月首都医科大学附属北京友谊医院收治的1例行小儿活体肝移植供者和受者的临床资料;供者男,年龄28岁,体质量为62 kg,身高为174 cm,体质量指数(BMI)为20.5 kg/m^(2)。受者为供者女儿,年龄1岁,体质量为9 kg,身高为75 cm,BMI为16.0 kg/m^(2)。供者行单孔腹腔镜肝左外叶供肝获取术。受者由同一手术团队行活体肝移植。观察指标:(1)术中情况。(2)术后情况。(3)随访情况。结果(1)术中情况。供者成功行单孔腹腔镜肝左外叶供肝获取术,术中经脐顺利放置单孔腹腔镜套筒,手术时间为240 min,供肝热缺血时间为3 min,术中出血量为40 mL,供肝质量为233.6 g,修正移植物与受者体质量比为2.60%。受者顺利行活体肝移植。(2)术后情况。供者于术后首日开始进食流质饮食,实验室检查结果:丙氨酸转氨酶(ALT)为239 U/L、天冬氨酸转氨酶(AST)为116 U/L、谷氨酰转移酶(GGT)为53 U/L、总胆红素(TBil)为22.57μmol/L;于术后第2天进食优质蛋白质饮食,并适度下床活动;术后第3天,腹腔引流液呈淡红色,行腹部B超检查结果未发现术区积液,拔除腹腔引流管;于术后第4天出院。受者于术后2周肝功能恢复正常。(3)随访情况。供者于出院后2周行门诊随访,实验室检查结果:ALT为44 U/L、AST为25 U/L、GGT为53 U/L、TBil为9.22μmol/L。供者和受者术后6个月内均无胆瘘、血管并发症等Clavien-Dino分级≥Ⅱ级并发症发生。结论单孔腹腔镜肝左外叶供肝获取术可应用于小儿活体肝移植。

Objective To investigate the application value of single-port laparoscopic left lateral donor liver acquisition in pediatric living donor liver transplantation(PLDLT).Methods The retrospective and descriptive study was conducted.The clinical data of the donor and recipient who were admitted to Beijing Friendship Hospital of Capital Medical University for PLDLT in January 2020 were collected.The donor was a male,aged 28 years with body mass as 62 kg,height as 174 cm and body mass index(BMI)as 20.5 kg/m^(2).The recipient was the daughter of the donor,aged 1 year with body mass as 9 kg,height as 75 cm and BMI as 16.0 kg/m^(2).The donor underwent single-port laparoscopic left lateral donor liver acquisition.The recipient underwent living donor liver trans-plantation by the same operation team.Observation indicators:(1)intraoperative conditions;(2)postoperative conditions;(3)follow-up.Results(1)Intraoperative conditions.The donor under-went single-port laparoscopic left lateral donor liver acquisition successfully,with the single-port access system being placed through a transumbilical incision.The operation time,the warm ischemia time of the donor liver and volume of intraoperative blood loss were 240 minutes,3 minutes and 40 mL,respectively,of the donor.The weight of the donor liver was 233.6 g,and the corrected graft-to-recipient body weight ratio was 2.60%.The recipient underwent living donor liver transplantation successfully.(2)Postoperative conditions.The donor began to take liquid diet at postoperative day 1,and results of laboratory examination showed that the alanine aminotransferase(ALT),aspartate aminotransferase(AST),glutamyltransferase(GGT)and total bilirubin(TBil)of the donor was 239 U/L,116 U/L,53 U/L and 22.57μmol/L.The donor began to take diet with high quality proteins at postoperative day 2,and to get for out-of-bed activities moderately.The donor′s peritoneal drainage fluid was light red at postoperative day 3,and no fluid accumulation was found in the operation area after abdominal B-ultrasound examination,so the peritoneal drainage tube was removed.The donor was discharged at postoperative day 4.The liver function of the recipient recovered to normal level 2 weeks after the operation.(3)Follow-up.The donor was followed up by outpatient examination 2 weeks after discharged,and results of laboratory examination showed that the ALT,AST,GGT and TBil was 44 U/L,25 U/L,53 U/L and 9.22μmol/L,respectively.Neither the donor nor the recipient had complication≥Ⅱgrade of the Clavien-Dino classification,such as biliary fistula and vascular complication during the 6 months after operation.Conclusion Single-port laparoscopic left lateral donor liver acquisition can be used into the PLDLT.