Soyama A, Takatsuki M, Hidaka M, Adachi T, Kitasato A, Kinoshita A, Natsuda K, Baimakhanov Z, Kuroki T, Eguchi S
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Transplant Proc. 2015 Apr;47(3):679-82. doi: 10.1016/j.transproceed.2015.02.016.
We have previously reported a hybrid procedure that uses a combination of laparoscopic mobilization of the liver and subsequent hepatectomy under direct vision in living donor liver transplantation (LDLT). We present the details of this hybrid procedure and the outcomes of the procedure.
Between January 1997 and August 2014, 204 LDLTs were performed at Nagasaki University Hospital. Among them, 67 recent donors underwent hybrid donor hepatectomy. Forty-one donors underwent left hemihepatectomy, 25 underwent right hemihepatectomy, and 1 underwent posterior sectionectomy. First, an 8-cm subxiphoid midline incision was made; laparoscopic mobilization of the liver was then achieved with a hand-assist through the midline incision under the pneumoperitoneum. Thereafter, the incision was extended up to 12 cm for the right lobe and posterior sector graft and 10 cm left lobe graft procurement. Under direct vision, parenchymal transection was performed by means of the liver-hanging maneuver. The hybrid procedure for LDLT recipients was indicated only for selected cases with atrophic liver cirrhosis without a history of upper abdominal surgery, significant retroperitoneal collateral vessels, or hypertrophic change of the liver (n = 29). For total hepatectomy and splenectomy, the midline incision was sufficiently extended.
All of the hybrid donor hepatectomies were completed without an extra subcostal incision. No significant differences were observed in the blood loss or length of the operation compared with conventional open procedures. All of the donors have returned to their preoperative activity level, with fewer wound-related complaints compared with those treated with the use of the conventional open procedure. In recipients treated with the hybrid procedure, no clinically relevant drawbacks were observed compared with the recipients treated with a regular Mercedes-Benz-type incision.
Our hybrid procedure was safely conducted with the same quality as the conventional open procedure in both LDLT donors and recipients.
我们之前报道了一种在活体肝移植（LDLT）中联合使用腹腔镜下肝脏游离及后续直视下肝切除术的混合手术方法。我们在此介绍该混合手术的详细情况及手术结果。
1997年1月至2014年8月期间，长崎大学医院共进行了204例LDLT手术。其中，67例近期供体接受了混合供体肝切除术。41例供体接受了左半肝切除术，25例接受了右半肝切除术，1例接受了后段肝切除术。首先，在剑突下做一个8cm的中线切口；然后在气腹下通过中线切口进行手辅助腹腔镜下肝脏游离。此后，对于右叶和后段移植物，切口延长至12cm，对于左叶移植物，切口延长至10cm以获取移植物。在直视下，通过肝脏悬吊法进行实质离断。LDLT受者的混合手术仅适用于选定的病例，这些病例为萎缩性肝硬化，无腹部手术史、明显的腹膜后侧支血管或肝脏肥大改变（n = 29）。对于全肝切除术和脾切除术，充分延长中线切口。
所有混合供体肝切除术均未额外做肋下切口完成。与传统开放手术相比，术中出血量和手术时间无显著差异。所有供体均已恢复至术前活动水平，与采用传统开放手术治疗的供体相比，伤口相关的不适更少。在接受混合手术的受者中，与采用常规梅赛德斯 - 奔驰型切口治疗的受者相比，未观察到临床相关的缺点。
我们的混合手术在LDLT供体和受者中均安全实施，且质量与传统开放手术相同。
