Yan Ji-Qi, Becker Thomas, Neipp Michael, Peng Cheng-Hong, Lueck Rainer, Lehner Frank, Li Hong-Wei, Klempnauer Juergen
Department of Surgery, Ruijin Hospital Affiliated to Shanghai Second Medical University, Shanghai 200025, China.
World J Gastroenterol. 2005 Jul 21;11(27):4220-4. doi: 10.3748/wjg.v11.i27.4220.
To outline the surgical experience with donor liver splitting in split liver transplantation.
From March 1 to September 1 in 2004, 10 donor livers were split ex situ into a left lateral lobe (segments II and III) and a right extended lobe (segments I, IV-VIII) in Medical School of Hannover, and thereafter split liver transplantation was performed successfully in 19 cases. The average age, weight and ICU staying period of the donors were 32.7 years (15-51 years), 64.5 kg (45-75 kg) and 2.4 d (1-8 d) respectively.
The average weight of the whole graft and the left lateral lobe was 1,322.6 g (956-1,665 g) and 281.8 g (198-373 g) respectively, and the average ratio of left lateral lobe to the whole graft was 0.215 (0.178-0.274). The average graft to recipient weight ratio (GRWR) of the left lateral lobe and the right extended lobe reached 2.44% (1.22-5.41%) and 1.73% (1.31-2.30%) respectively. On average it took approximately 105 min (85-135 min) to split the donor liver. Five donor organs showed anatomic variation including the left hepatic vein variation in two cases, the left hepatic artery variation in two cases and the bile duct variation in one case.
Split liver transplantation has become a mature surgical technique to expand the donor pool with promising results. In the process of graft splitting, close attention needs to be paid to potential anatomic variations, especially to variations of the left hepatic vein, the left hepatic artery, and the bile duct.
概述劈离式肝移植中供肝劈离的手术经验。
2004年3月1日至9月1日，在汉诺威医学院将10个供肝在体外劈离为左外叶（Ⅱ、Ⅲ段）和右扩展叶（Ⅰ、Ⅳ-Ⅷ段），随后成功为19例患者实施了劈离式肝移植。供者的平均年龄、体重和重症监护病房停留时间分别为32.7岁（15-51岁）、64.5千克（45-75千克）和2.4天（1-8天）。
整个移植物和左外叶的平均重量分别为1322.6克（956-1665克）和281.8克（198-373克），左外叶与整个移植物的平均重量比为0.215（0.178-0.274）。左外叶和右扩展叶的平均移植物与受者体重比（GRWR）分别达到2.44%（1.22-5.41%）和1.73%（1.31-2.30%）。供肝劈离平均耗时约105分钟（85-135分钟）。5个供肝器官存在解剖变异，包括2例左肝静脉变异、2例左肝动脉变异和1例胆管变异。
劈离式肝移植已成为一种成熟的手术技术，可扩大供肝来源，效果良好。在移植物劈离过程中，需要密切关注潜在的解剖变异，尤其是左肝静脉、左肝动脉和胆管的变异。
