Akpek Elif A, Arslan Gülnaz, Erkaya Ciğdem, Torgay Adnan, Dönmez Asli, Kayhan Zeynep, Karakayali Hamdi
Department of Anesthesiology, Başkent University School of Medicine, Ankara, Turkey.
Transpl Int. 2003 Aug;16(8):486-90. doi: 10.1007/s00147-003-0614-2. Epub 2003 Jun 18.
Liver transplantation involving living-related donors has been adopted in many centers as a way of relieving organ shortage. This study reviewed the anesthetic considerations for donor operations at our institution in relation to intraoperative blood transfusion, complications, and postoperative liver function test results. From January 1990 to May 2001, 30 living-related liver transplantations were performed at Başkent University Hospital, Ankara. The donor data used for analysis were retrospectively obtained through chart review, anesthesia records, and the computerized hospital database. Left lobectomy was performed in 19 cases, and left lateral segmentectomy in 11 cases. Intraoperatively, the average volume of intravenous fluids used was 6431+/-468 ml, and the average amount of blood transfused was 2.1+/-0.4 units. The mean postoperative hospital stay was 11.5+/-1.3 days. The only intraoperative complication observed in these 30 donors was severe bleeding during retrohepatic vena cava dissection in one of the cases. The postoperative complications related to anesthesia were one case each of shoulder pain, neuropraxia, and compartment syndrome. The levels of total and direct bilirubin, aspartate aminotransferase, and alanine aminotransferase peaked within the first 2 postoperative days (2.19+/-0.36 mg/dl, 1.02+/-0.18 mg/dl, 245.7+/-26.6 U/l, 313.5+/-51.9 U/l, respectively). In all 30 donors, these levels had normalized by 1 month after surgery. Maximal efforts must be applied in the anesthetic approach to minimize donor complications in living-related liver transplantation; however, this will not completely eliminate some risks to the donor.
涉及活体亲属供体的肝移植已在许多中心被采用，作为缓解器官短缺的一种方式。本研究回顾了我院供体手术的麻醉相关因素，包括术中输血、并发症及术后肝功能检查结果。1990年1月至2001年5月，安卡拉的巴什肯特大学医院进行了30例活体亲属肝移植手术。用于分析的供体数据通过病历审查、麻醉记录和医院计算机数据库回顾性获取。19例行左叶切除术，11例行左外侧段切除术。术中，静脉输液平均用量为6431±468ml，平均输血量为2.1±0.4单位。术后平均住院时间为11.5±1.3天。这30例供体中观察到的唯一术中并发症是1例在肝后下腔静脉分离时发生严重出血。与麻醉相关的术后并发症分别为1例肩痛、1例神经失用和1例骨筋膜室综合征。总胆红素、直接胆红素、天冬氨酸转氨酶和丙氨酸转氨酶水平在术后第1天达到峰值（分别为2.19±0.36mg/dl、1.02±0.18mg/dl、245.7±26.6U/L、313.5±51.9U/L）。在所有30例供体中，这些指标在术后1个月时均恢复正常。在活体亲属肝移植的麻醉方法中必须尽最大努力将供体并发症降至最低；然而，这并不能完全消除对供体的一些风险。
