活體右半肝供肝切取的經驗_《中國普外基礎與臨床雜志》

作者：

蔣文濤 , 張驪 , 曾志貴 , 魏林 , 朱志軍 , 鄭虹 , 潘澄 , 鄧永林 , 沈中陽

天津市第一中心醫院器官移植中心（天津 300192）;

關鍵詞：

活體肝移植供肝切取手術經驗圍手術期

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目的對活體右半肝供肝切取手術經驗進行總結。方法回顧性分析我中心單一外科小組2007年8月至2008年12月期間連續實施右半肝切取的76例供者資料。術前綜合考慮移植物大小、殘肝比例、有無脂肪肝、肝中靜脈類型及受體術前門靜脈高壓情況，以確定是否帶肝中靜脈。術中以缺血線確定肝切平面，以術中B超了解肝中靜脈的走向及分支，肝切線在肝中靜脈左或右側緊貼肝中靜脈。行術中膽道造影，了解膽道結構及變異。記錄手術時間，術中失血量，術后住院時間，術后住院期間總膽紅素、國際標準化比值（INR）和ALT水平變化情況以及術后各種并發癥發生情況。結果 76例供體均順利完成手術，手術時間（8.3±1.3） h，術中失血量（325±127） ml，術中均未輸血。總膽紅素、INR和ALT水平于術后第12天恢復正常。本組供體術后住院期間最常見并發癥是傷口感染（共5例），膽汁郁積4例，斷面漏膽4例; 11例患者于術后4～7 d出現不同程度的胃排空障礙；均經相應處理后好轉。術后住院9～21 d，中位時間14 d。結論充分的術前評估以及精準的術中操作能夠保證供肝的順利切取并有利于供體的術后恢復。

引用本文： 蔣文濤,張驪,曾志貴,魏林,朱志軍,鄭虹,潘澄,鄧永林,沈中陽. 活體右半肝供肝切取的經驗. 中國普外基礎與臨床雜志, 2010, 17(6): 528-531. doi: 復制

1.	朱志軍，侯建存，張雅敏, 等. 活體右半肝移植肝中靜脈取舍選擇與供受者的安全性 [J]. 中華醫學雜志， 2009， 89（26）： 1825-1829.
2.	Gruttadauria S, Marsh JW, Vizzini GB, et al. Analysis of surgical and perioperative complications in seventy-five right hepatectomies for living donor liver transplantation [J]. World J Gastroenterol, 2008; 14(20): 3159-3164.
3.	Hasegawa Y, Kawachi S, Shimazu M, et al. Discontinuation of living donor liver transplantation for PSC due to histological abnormalities in intraoperative donor liver biopsy [J]. Am J Transplant, 2007; 7(9): 2204-2207.
4.	Tanaka K, Uemoto S, Tokunaga Y, et al. Surgical techniques and innovations in living related liver transplantation. [J]. Ann Surg, 1993; 217(1): 82-91.
5.	Kubota K, Makuuchi M, Takayama T, et al. Successful hepatic vein reconstruction in 42 consecutive living related liver transplantations [J]. Surgery, 2000; 128(1): 48-53.
6.	Moon DB, Lee SG. Adult-to-adult living donor liver transplantation at the Asan Medical Center [J]. Yonsei Med J, 2004; 45(6): 1162-1168.
7.	Orguc S, Tercan M, Bozoklar A, et al. Variations of hepatic veins: helical computerized tomography experience in 100 consecutive living liver donors with emphasis on right lobe [J]. Transplant Proc, 2004; 36(9): 2727-2732.
8.	陳擁軍，彭承宏，沈柏用, 等. 成人間活體肝移植供體行改良擴大右半肝切除的安全性 [J]. 外科理論與實踐, 2008; 13（4）: 316-321.
9.	Grewal HP, Thistlewaite JR Jr, Loss GE, et al. Complications in 100 living-liver donors [J]. Ann Surg, 1998; 228(2): 214-219.
10.	Ikegami T, Nishizaki T, Yanaga K, et al. Changes in the caudate lobe that is transplanted with extended left lobe liver graft from living donors [J]. Surgery, 2001; 129(1): 86-90.
11.	Azoulay D, Marin-Hargreaves G, Castaing D, et al. Duct-to-duct biliary anastomosis in living related liver transplantation: the Paul Brousse technique [J]. Arch Surg, 2001; 136(10): 1197-1200.
12.	Sterneck MR, Fischer L, Nischwitz U, et al. Selection of the living liver donor [J]. Transplantation, 1995; 60(7): 667-671.
13.	Cho EH, Suh KS, Lee HW, et al. Safety of modified extended right hepatectomy in living liver donors [J]. Transpl Int, 2007; 20(9): 779-783.
14.	Fan ST, Lo CM, Liu CL, et al. Safety and necessity of including the middle hepatic vein in the right lobe graft in adult-to-adult live donor liver transplantation [J]. Ann Surg, 2003; 238(1): 137-148.
15.	Marcos A, Ham JM, Fisher RA, et al. Single-center analysis of the first 40 adult-to-adult living donor liver transplants using the right lobe [J]. Liver Transpl, 2000; 6(3): 296-301.
16.	Grewal HP, Shokouh-Amiri MH, Vera S, et al. Surgical technique for right lobe adult living donor liver transplantation without venovenous bypass or portocaval shunting and with duct-to-duct biliary reconstruction [J]. Ann Surg, 2001; 233(4): 502-508.
17.	Inomata Y, Uemoto S, Asonuma K, et al. Right lobe graft in living donor liver transplantation [J]. Transplantation, 2000; 69(2): 258-264.
18.	Middleton PF, Duffield M, Lynch SV, et al. Living donor liver transplantation-adult donor outcomes: a systematic review [J]. Liver Transpl, 2006; 12(1): 24-30.
19.	Ghobrial RM, Hsieh CB, Lerner S, et al. Technical challenges of hepatic venous outflow reconstruction in right lobe adult living donor liver transplantation [J]. Liver Transpl, 2001; 7(6): 551-555.
20.	陳虎，張愷欣，王瑞, 等. 前入路繞肝提拉法在復雜右半肝切除中的應用體會 [J]. 醫學信息(內·外科版), 2009; 22(8): 711-712.
21.	Heaton N. Small-for-size liver syndrome after auxiliary and split liver transplantation: donor selection [J]. Liver Transpl, 2003; 9(9): S26-S28.
22.	Poon RT, Chan J, Fan ST. Left hepatic vein kinking after right trisegmentectomy: a potential cause of postoperative liver failure [J]. Hepatogastroenterology, 1998; 45(20): 508-509.
23.	Masselot R, Leborgne J. Anatomical study of the hepatic veins [J]. Anat Clin, 1978; 1: 109-125.
24.	Imamura H, Makuuchi M, Sakamoto Y, et al. Anatomical keys and pitfalls in living donor liver transplantation [J]. J Hepatobiliary Pancreat Surg, 2000; 7(4): 380-394.
25.	El Moghazy WM, Hedaya MS, Kaido T, et al. Two different methods for donor hepatic transection: cavitron ultrasonic surgical aspirator with bipolar cautery versus cavitron ultrasonic surgical aspirator with radiofrequency coagulator-A randomized controlled trial [J]. Liver Transpl, 2009; 15(1): 102-105.

1. 朱志軍，侯建存，張雅敏, 等. 活體右半肝移植肝中靜脈取舍選擇與供受者的安全性 [J]. 中華醫學雜志， 2009， 89（26）： 1825-1829.
2. Gruttadauria S, Marsh JW, Vizzini GB, et al. Analysis of surgical and perioperative complications in seventy-five right hepatectomies for living donor liver transplantation [J]. World J Gastroenterol, 2008; 14(20): 3159-3164.
3. Hasegawa Y, Kawachi S, Shimazu M, et al. Discontinuation of living donor liver transplantation for PSC due to histological abnormalities in intraoperative donor liver biopsy [J]. Am J Transplant, 2007; 7(9): 2204-2207.
4. Tanaka K, Uemoto S, Tokunaga Y, et al. Surgical techniques and innovations in living related liver transplantation. [J]. Ann Surg, 1993; 217(1): 82-91.
5. Kubota K, Makuuchi M, Takayama T, et al. Successful hepatic vein reconstruction in 42 consecutive living related liver transplantations [J]. Surgery, 2000; 128(1): 48-53.
6. Moon DB, Lee SG. Adult-to-adult living donor liver transplantation at the Asan Medical Center [J]. Yonsei Med J, 2004; 45(6): 1162-1168.
7. Orguc S, Tercan M, Bozoklar A, et al. Variations of hepatic veins: helical computerized tomography experience in 100 consecutive living liver donors with emphasis on right lobe [J]. Transplant Proc, 2004; 36(9): 2727-2732.
8. 陳擁軍，彭承宏，沈柏用, 等. 成人間活體肝移植供體行改良擴大右半肝切除的安全性 [J]. 外科理論與實踐, 2008; 13（4）: 316-321.
9. Grewal HP, Thistlewaite JR Jr, Loss GE, et al. Complications in 100 living-liver donors [J]. Ann Surg, 1998; 228(2): 214-219.
10. Ikegami T, Nishizaki T, Yanaga K, et al. Changes in the caudate lobe that is transplanted with extended left lobe liver graft from living donors [J]. Surgery, 2001; 129(1): 86-90.
11. Azoulay D, Marin-Hargreaves G, Castaing D, et al. Duct-to-duct biliary anastomosis in living related liver transplantation: the Paul Brousse technique [J]. Arch Surg, 2001; 136(10): 1197-1200.
12. Sterneck MR, Fischer L, Nischwitz U, et al. Selection of the living liver donor [J]. Transplantation, 1995; 60(7): 667-671.
13. Cho EH, Suh KS, Lee HW, et al. Safety of modified extended right hepatectomy in living liver donors [J]. Transpl Int, 2007; 20(9): 779-783.
14. Fan ST, Lo CM, Liu CL, et al. Safety and necessity of including the middle hepatic vein in the right lobe graft in adult-to-adult live donor liver transplantation [J]. Ann Surg, 2003; 238(1): 137-148.
15. Marcos A, Ham JM, Fisher RA, et al. Single-center analysis of the first 40 adult-to-adult living donor liver transplants using the right lobe [J]. Liver Transpl, 2000; 6(3): 296-301.
16. Grewal HP, Shokouh-Amiri MH, Vera S, et al. Surgical technique for right lobe adult living donor liver transplantation without venovenous bypass or portocaval shunting and with duct-to-duct biliary reconstruction [J]. Ann Surg, 2001; 233(4): 502-508.
17. Inomata Y, Uemoto S, Asonuma K, et al. Right lobe graft in living donor liver transplantation [J]. Transplantation, 2000; 69(2): 258-264.
18. Middleton PF, Duffield M, Lynch SV, et al. Living donor liver transplantation-adult donor outcomes: a systematic review [J]. Liver Transpl, 2006; 12(1): 24-30.
19. Ghobrial RM, Hsieh CB, Lerner S, et al. Technical challenges of hepatic venous outflow reconstruction in right lobe adult living donor liver transplantation [J]. Liver Transpl, 2001; 7(6): 551-555.
20. 陳虎，張愷欣，王瑞, 等. 前入路繞肝提拉法在復雜右半肝切除中的應用體會 [J]. 醫學信息(內·外科版), 2009; 22(8): 711-712.
21. Heaton N. Small-for-size liver syndrome after auxiliary and split liver transplantation: donor selection [J]. Liver Transpl, 2003; 9(9): S26-S28.
22. Poon RT, Chan J, Fan ST. Left hepatic vein kinking after right trisegmentectomy: a potential cause of postoperative liver failure [J]. Hepatogastroenterology, 1998; 45(20): 508-509.
23. Masselot R, Leborgne J. Anatomical study of the hepatic veins [J]. Anat Clin, 1978; 1: 109-125.
24. Imamura H, Makuuchi M, Sakamoto Y, et al. Anatomical keys and pitfalls in living donor liver transplantation [J]. J Hepatobiliary Pancreat Surg, 2000; 7(4): 380-394.
25. El Moghazy WM, Hedaya MS, Kaido T, et al. Two different methods for donor hepatic transection: cavitron ultrasonic surgical aspirator with bipolar cautery versus cavitron ultrasonic surgical aspirator with radiofrequency coagulator-A randomized controlled trial [J]. Liver Transpl, 2009; 15(1): 102-105.

《中國普外基礎與臨床雜志》

活體右半肝供肝切取的經驗

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《中國普外基礎與臨床雜志》

活體右半肝供肝切取的經驗

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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