亲属活体供肝肝移植中供体安全的术后管理

Sato Yoshinobu, Kurosaki Isao, Yamamoto Satoshi, Nakatsuka Hideki, Oya Hiroshi, Shirai Yoshio, Tanaka Koichi, Hatakeyama Katsuyoshi

First Department of Surgery, School of Medicine, Niigata University, 1-757 Asahimachi-dori, Niigata 951-8510, Japan.

Hepatogastroenterology. 2003 Jan-Feb;50(49):196-200.

BACKGROUND/AIMS: Living related donor liver transplantation must hold on in absolute donor safety. Nevertheless, the risks to the donors are increased because of the use of right lobe for size mismatch. Therefore the intensive management for donor operation can hardly be overestimated. In this study, we investigated the utility of prostaglandin E1, methylprednisolone and C-tube in the postoperative management for donor operation based on our understanding of the mechanisms of liver injury after massive hepatectomy.

METHODOLOGY

Outcome of the thirteen donors, whose right lobe was removed (right lobe group: 7 cases) or the left lobe only (3 cases) and left lobe plus caudate lobe (3 cases) (left lobe group: 6 cases) from 1999 March to 2000 August, for living related liver transplantation were evaluated. Indication for right lobe living related liver transplantation was basically defined as an estimated left lobe volume/recipient body weight ratio (GVBW ratio) of < 0.8% (range: 0.65-1.4, right lobe group: 1.05 +/- 0.18, left lobe group: 0.89 +/- 0.16).

RESULTS

The donors recovered from the operation without the differentiation between right and left lobe group. There were no significant differences in the operative time, the operative hemorrhage, the hospital stays and the postoperative liver function in the two groups. They had no bile leakage and no serious complications. We experienced the left lobe donor who suffered from a cholangitis without any infection and he recovered by the administration of prostaglandin E1 and steroid. They improved bile secretion and bilirubinemia. Eleven recipients (84.6%) were successfully treated. The two causes of death were the sepsis (right lobe) and brain hemorrhage (left lobe).

CONCLUSIONS

The current series of right lobe donation was able to show successful results as well as left lobe donation by the postoperative management with steroid, prostaglandin E1 and C-tube drainage based on our understanding of liver injury after massive hepatectomy in the adult-to-adult living donor liver transplantation.

背景/目的：亲属活体供肝移植必须确保供体的绝对安全。然而，由于右半肝移植用于处理供肝与受体大小不匹配问题，供体的风险增加。因此，供体手术的强化管理至关重要。在本研究中，基于我们对大范围肝切除术后肝损伤机制的理解，我们探讨了前列腺素E1、甲基强的松龙和C管在供体手术术后管理中的作用。

方法

对1999年3月至2000年8月期间，为亲属活体肝移植而切除右半肝（右半肝组：7例）或仅切除左半肝（3例）以及左半肝加尾状叶（3例）（左半肝组：6例）的13例供体的结果进行评估。右半肝亲属活体肝移植的指征基本定义为估计的左半肝体积/受体体重比（GVBW比）<0.8%（范围：0.65 - 1.4，右半肝组：1.05±0.18，左半肝组：0.89±0.16）。

结果

供体术后均康复，右半肝组和左半肝组之间无差异。两组在手术时间、术中出血、住院时间和术后肝功能方面均无显著差异。无胆漏及严重并发症发生。我们遇到1例左半肝供体发生胆管炎，但无任何感染迹象，经给予前列腺素E1和类固醇后康复。胆汁分泌及胆红素血症均有改善。11例受体（84.6%）治疗成功。死亡原因2例，分别为脓毒症（右半肝）和脑出血（左半肝）。