With the dawn of organ donation after a citizen's death in China,the use of split-liver transplantation(SLT)can effectively increase the source of donor liver,reduce the waiting time for organ transplantation in p...With the dawn of organ donation after a citizen's death in China,the use of split-liver transplantation(SLT)can effectively increase the source of donor liver,reduce the waiting time for organ transplantation in patients,and particularly solve the problem of organ shortage in children.In recent years,many transplantation centers have been performing SLT to varying degrees and efficacy.At the current stage,the experiences of countries with advanced transplantation techniques should be used to establish an SLT consensus that is suitable for China to further increase the ratio and efficacy of SLT.In this paper,we combined expert experiences to generate an SLT expert consensus that included donor and donor liver evaluation,recipient selection criteria,donor and recipient matching,selection of splitting form and tools,blood vessels and bile ducts dissection and allocation,perioperative management of SLT,and organ allocation.展开更多
目的介绍右半肝劈离式肝移植时采用的简化“All in one”的肝静脉重建手术方式,探讨该术式的临床适应证、操作方式和预后。方法回顾性分析2例完全右半肝劈离式肝移植的病例资料,就右半肝肝静脉采用简化“All in one”重建方式进行总结...目的介绍右半肝劈离式肝移植时采用的简化“All in one”的肝静脉重建手术方式,探讨该术式的临床适应证、操作方式和预后。方法回顾性分析2例完全右半肝劈离式肝移植的病例资料,就右半肝肝静脉采用简化“All in one”重建方式进行总结分析。2例右半肝均为在体劈离,例1采用劈离肝实质至第一、二肝门,离断右肝管后整体灌注获取,台下分割肝脏血管的方法。例2采用在体劈离时先行获取左半肝,右半肝行在体灌注后获取。2例供肝劈离时均将肝中静脉主干保留于左半肝,右半肝的S5、S8段肝静脉采用同一供者髂动脉重建,并直接吻合于下腔静脉上原肝左和肝中静脉离断后的缺口,重建了肝后下腔静脉的完整性。结果采用简化“All in one”右半肝肝静脉重建方式,2例肝移植无肝期分别为41、36 min。肝脏开放后供肝回流良好,搭桥的髂动脉血管充盈满意,无肝脏淤血肿胀等表现,术后肝功能恢复顺利。分别随访1年11个月和10个月,无肝静脉和下腔静脉等流出道相关并发症发生。结论完全右半肝劈离式肝移植时,采用“All in one”的肝静脉重建方式可以简化移植肝脏流出道重建步骤、缩短无肝期时间,减少术后肝静脉并发症的发生。展开更多
基金This workwas supported by the National 13th 5-year Plan Major Science and Technology Research Project(2017ZX10203205-006-001)National Key Research and Development Program of China(2017YFA0104304)+3 种基金National Natural Science Foundation of China(81570593,81670601,81770648,81870449,81972286)Natural Science Foundation of Guangdong Province(2015A030312013,2016A030313224,2017A030311034)Science and Technology Planning Project of Guangdong Province(2017B020209004,20169013,2017B030314027)Guangzhou Science and Technology Planning Project(2014Y2-00200,201604020001,201508020262,201400000001-3,201607010024).
文摘With the dawn of organ donation after a citizen's death in China,the use of split-liver transplantation(SLT)can effectively increase the source of donor liver,reduce the waiting time for organ transplantation in patients,and particularly solve the problem of organ shortage in children.In recent years,many transplantation centers have been performing SLT to varying degrees and efficacy.At the current stage,the experiences of countries with advanced transplantation techniques should be used to establish an SLT consensus that is suitable for China to further increase the ratio and efficacy of SLT.In this paper,we combined expert experiences to generate an SLT expert consensus that included donor and donor liver evaluation,recipient selection criteria,donor and recipient matching,selection of splitting form and tools,blood vessels and bile ducts dissection and allocation,perioperative management of SLT,and organ allocation.
文摘目的介绍右半肝劈离式肝移植时采用的简化“All in one”的肝静脉重建手术方式,探讨该术式的临床适应证、操作方式和预后。方法回顾性分析2例完全右半肝劈离式肝移植的病例资料,就右半肝肝静脉采用简化“All in one”重建方式进行总结分析。2例右半肝均为在体劈离,例1采用劈离肝实质至第一、二肝门,离断右肝管后整体灌注获取,台下分割肝脏血管的方法。例2采用在体劈离时先行获取左半肝,右半肝行在体灌注后获取。2例供肝劈离时均将肝中静脉主干保留于左半肝,右半肝的S5、S8段肝静脉采用同一供者髂动脉重建,并直接吻合于下腔静脉上原肝左和肝中静脉离断后的缺口,重建了肝后下腔静脉的完整性。结果采用简化“All in one”右半肝肝静脉重建方式,2例肝移植无肝期分别为41、36 min。肝脏开放后供肝回流良好,搭桥的髂动脉血管充盈满意,无肝脏淤血肿胀等表现,术后肝功能恢复顺利。分别随访1年11个月和10个月,无肝静脉和下腔静脉等流出道相关并发症发生。结论完全右半肝劈离式肝移植时,采用“All in one”的肝静脉重建方式可以简化移植肝脏流出道重建步骤、缩短无肝期时间,减少术后肝静脉并发症的发生。
