Fujita S, Kim I D, Uryuhara K, Asonuma K, Egawa H, Kiuchi T, Hayashi M, Uemeto S, Inomata Y, Tanaka K
Kyoto University Hospital, Kyoto University, Japan.
Transpl Int. 2000;13(5):333-9. doi: 10.1007/s001470050710.
Living donor-morbidity was evaluated in 470 consecutive cases of living donor liver transplantation carried out from June 1990 to May 1999 at Kyoto University. Grafting was categorized into 4 groups according to the resection lines; left lateral segmentectomy (S2 + 3, n = 282, R1), extended left lateral segmentectomy without middle hepatic vein (MHV) (S2 + 3 + part4, n = 45, R2), left lobectomy with MHV (S2 + 3 + 4, n = 99, R3) and right lobectomy without MHV (S5 + 6 + 7 + 8, n = 43, R4). Intraoperative blood loss and operation duration were less for left lateral segmentectomy, but no significant difference was observed between left lobectomy and right lobectomy. The length of postoperative hospital stays was comparable among all groups except for the group with right lobe grafting. The AST values at the peak and at POD 7 were significantly elevated for right lobectomy, but the AST value normalized within one month in the majority of the cases. The close follow-up of donors with more than 1,000 ml intraoperative bleeding, and of those donors who stayed in hospital for more than 30 days, the close follow-up, furthermore, of those donors with AST values higher than 100 IU/ L AST after one month, revealed complete recovery. Biliary leakage was the most common and annoying complication after donor operations, especially in for right lobe grafting, but all donors recovered completely with conservative or minimal invasive therapy. The two cases of re-operation due to adhesive mechanical ileus we encountered were resolved completely. Finally, no donor-operation related death was noted. In conclusion, the morbidity of living donors is low or minimal even for right lobectomy, the most extended procedure, and complete recovery can be expected in all cases.
对1990年6月至1999年5月在京都大学连续进行的470例活体肝移植供体的发病情况进行了评估。根据切除线将移植分为4组：左外叶切除术（S2 + 3，n = 282，R1）、无肝中静脉（MHV）的扩大左外叶切除术（S2 + 3 + 部分4，n = 45，R2）、保留MHV的左叶切除术（S2 + 3 + 4，n = 99，R3）和无MHV的右叶切除术（S5 + 6 + 7 + 8，n = 43，R4）。左外叶切除术的术中失血量和手术时间较少，但左叶切除术和右叶切除术之间未观察到显著差异。除右叶移植组外，所有组的术后住院时间相当。右叶切除术时，峰值和术后第7天的AST值显著升高，但大多数病例的AST值在1个月内恢复正常。对术中出血超过1000 ml的供体、住院超过30天的供体以及术后1个月AST值高于100 IU/L的供体进行密切随访，结果显示均完全康复。胆漏是供体手术后最常见且令人烦恼的并发症，尤其是在右叶移植时，但所有供体通过保守或微创治疗均完全康复。我们遇到的2例因粘连性机械性肠梗阻而再次手术的病例也完全康复。最后未发现与供体手术相关的死亡病例。总之，即使是最广泛的右叶切除术，活体供体的发病率也很低或极小，所有病例均可预期完全康复。
