Yan Lu-Nan, Li Bo, Zeng Yong, Wen Tian-Fu, Zhao Ji-Chun, Wang Wen-Tao, Yang Jia-Yin, Xu Ming-Qing, Ma Yu-Kui, Chen Zhe-Yu, Liu Jiang-Wen, Wu Hong
Liver Transplantation Division, Department of Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
Hepatobiliary Pancreat Dis Int. 2006 May;5(2):173-9.
Because of critical organ shortage, transplant professionals have utilized living donor liver transplantation (LDLT) in recent years. We summarized our experience in adult-to- adult LDLT with grafts of right liver lobe by a modified technique.
From January 2002 to August 2005, 24 adult patients underwent living donor liver transplantation with grafts of the right liver lobe at West China Hospital, Sichuan University, China. Twenty-two patients underwent modified procedures designed to improve the reconstruction of the right hepatic vein and the tributaries of the middle hepatic vein by interposing a great saphenous vein (GSV) graft and the anastomosis of the hepatic arteries and bile ducts.
No severe complications and death occurred in all donors. In the first 2 patients, (patients 1 and 2), operative procedure was not modified. One patient suffered from "small-for-size syndrome" and the other died of sepsis with progressive deterioration of graft function. In the rest 22 patients (patients 3 to 24), however, the procedure of venous reconstruction was modified, and better results were obtained. Complications occurred in 7 recipients including acute rejection (2 patients), hepatic artery thrombosis (1), bile leakage (1), intestinal bleeding (1), left subphrenic abscess (1), and pulmonary infection (1). One patient with pulmonary infection died of multiple organ failure (MOF). The 22 patients underwent direct anastomosis of the right hepatic vein to the inferior vena cava (IVC), 9 direct anastomosis plus the reconstruction of the right inferior hepatic vein, and 10 direct anastomosis plus the reconstruction of the tributaries of the middle hepatic vein by interposing a GSV graft to provide sufficient venous outflow. Trifurcation of the portal vein was met in 3 patients. Venoplasty or separate anastomosis was performed. The ratio of graft to recipient body weight ranged from 0.72% to 1.17%. Among these patients, 19 had the ratio <1.0% and 4 <0.8%, and the ratio of graft weight to recipient standard liver volume was between 31.86% and 62.48%. Among these patients, 10 had the ratio <50% and 2 <40%. No "small-for-size syndrome" occurred in the 22 recipients who were subjected to modified procedures.
With the modified surgical techniques for the reconstruction of the hepatic vein to obtain an adequate outflow and provide a sufficient functioning liver mass, living donor liver graft in adults using the right lobe can be safe to prevent the "small-for-size syndrome".
由于关键器官短缺，近年来移植专业人员采用了活体供肝肝移植（LDLT）。我们总结了采用改良技术进行成人对成人右肝叶活体供肝肝移植的经验。
2002年1月至2005年8月，24例成年患者在中国四川大学华西医院接受了右肝叶活体供肝肝移植。22例患者接受了改良手术，通过置入大隐静脉（GSV）移植物以及肝动脉和胆管吻合术，以改善右肝静脉和肝中静脉分支的重建。
所有供体均未发生严重并发症及死亡。最初的2例患者（患者1和患者2）未进行手术改良。1例患者发生“小肝综合征”，另1例死于败血症，移植肝功能逐渐恶化。然而，在其余22例患者（患者3至24）中，静脉重建手术进行了改良，获得了更好的效果。7例受者发生并发症，包括急性排斥反应（2例）、肝动脉血栓形成（1例）、胆漏（1例）、肠道出血（1例）、左膈下脓肿（1例）和肺部感染（1例）。1例肺部感染患者死于多器官功能衰竭（MOF）。22例患者中，22例将右肝静脉直接与下腔静脉（IVC）吻合，9例直接吻合加右肝下静脉重建，10例直接吻合加通过置入GSV移植物重建肝中静脉分支，以提供足够的静脉流出道。3例患者出现门静脉三叉分支。进行了静脉成形术或单独吻合。移植物与受者体重之比在0.72%至1.17%之间。其中，19例该比例<1.0%，4例<0.8%，移植物重量与受者标准肝体积之比在31.86%至62.48%之间。其中，10例该比例<50%，2例<40%。在接受改良手术的22例受者中未发生“小肝综合征”。
采用改良的肝静脉重建手术技术以获得足够的流出道并提供足够的有功能肝体积，使用右叶进行成人活体供肝移植可安全预防“小肝综合征”。
