成人活体部分肝移植的临床抉择

Clinical Decision for Adult Living Related Partial Liver Transplantation

目的 探讨成人活体部分肝移植中供肝移植物大小与术式的临床抉择。方法 采用文献回顾的方法对活体部分肝移植中供体的评估、供肝大小的判断与选择、切取术式 ,以及供体安全性等加以综述。结果 供肝移植物大小是影响供体安全性与受体预后的关键因素 ,临床有带肝中静脉的左半肝移植、含左侧尾叶的扩大左半肝移植、右半肝移植以及带肝中静脉的扩大右半肝移植可供选择 ,以使供肝与受体标准肝大小之比 (GW /ESLW ) ≥3 0 % ,供肝与受体体重之比 (GW /BW ) ≥0 .8%。结论 根据GW /ESLW以及GW /BW预测值 ,结合肝脏解剖特点 ,选择合理的供肝切除术是具有重要的临床意义。

Objective To investigate the clinical choice on graft size and the type of donor's hepatectomy in adult living related partial liver transplantation. Methods The literatures in recent years on the donor's evaluation, the size of liver grafts, the types of donor hepatectomy and safety of donor in adult living related partial liver transplantation were reviewed.Results The size of liver graft is a crucial factor related to the safety of donor and the prognosis of the recipient. GW/ESLW≥30%, GW/BW≥0.8% may be the lowest limits. Left lobe contained middle hepatic vein, extended left lobe with left-side caudle lobe, right lobe or extended right lobe contained middle hepatic vein may be the practical choice.Conclusion It is important to make a reasonable choice of liver graft according to the estimation of GW/ESLW or GW/BW, and the anatomy of liver in adult living related partial liver transplantation.