Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxin Road, Beijing, 100853, China.
Hepatol Int. 2015 Oct;9(4):603-11. doi: 10.1007/s12072-015-9628-y. Epub 2015 May 15.
Cholecystectomy is routinely performed at most transplant centers during living donor liver transplantation (LDLT). This study was performed to evaluate the feasibility of liver graft procurement with donor gallbladder preservation in LDLT.
Eighty-nine LDLTs (from June 2006 to Dec 2012) were retrospectively analyzed at our hospital. The surgical approach for liver graft procurement with donor gallbladder preservation was assessed, and the anatomy of the cystic artery, the morphology and contractibility of the preserved gallbladder, postoperative symptoms, and vascular and biliary complications were compared among donors with or without gallbladder preservation.
Twenty-eight donors (15 right and 13 left-liver grafts) successfully underwent liver graft procurement with gallbladder preservation. Among the 15 right lobectomy donors, for 12 cases (80.0 %) the cystic artery originated from right hepatic artery. From the left hepatic artery and proper hepatic artery accounted for 6.7 % (1/15), respectively. Postoperative symptoms among these 28 donors were slight, although donors with cholecystectomy often complained of fatty food aversion, dyspepsia, and diarrhea during an average follow-up of 58.6 (44-78) months. The morphology and contractibility of the preserved gallbladders were comparable with normal status; the rate of contraction was 53.8 and 76.7 %, respectively, 30 and 60 min after ingestion of a fatty meal. Biliary and vascular complications among donors and recipients, irrespective of gallbladder preservation, were not significantly different.
These data suggest that for donors compliant with anatomical requirements, liver graft procurement with gallbladder preservation for the donor is feasible and safe. The preserved gallbladder was assessed as functioning well and postoperative symptoms as a result of cholecystectomy were significantly reduced during long-term follow-up.
在大多数肝移植中心，活体供肝移植（LDLT）期间常规行胆囊切除术。本研究旨在评估在 LDLT 中保留供体胆囊获取肝移植物的可行性。
对我院 2006 年 6 月至 2012 年 12 月期间 89 例 LDLT 进行回顾性分析。评估保留供体胆囊的肝移植物获取的手术方法，并比较有无保留胆囊的供体胆囊动脉解剖、保留胆囊的形态和收缩性、术后症状以及血管和胆道并发症。
28 例供体（15 例右半肝和 13 例左半肝）成功施行保留胆囊的肝移植物获取术。在 15 例右半肝切除术供体中，12 例（80.0%）胆囊动脉起源于右肝动脉，分别有 6.7%（1/15）起源于左肝动脉和肝固有动脉。尽管行胆囊切除术的供体在平均 58.6（44-78）个月的随访中经常抱怨厌油腻食物、消化不良和腹泻，但这些 28 例供体的术后症状轻微。保留胆囊的形态和收缩性与正常状态相当，分别在进餐后 30 和 60 min 时收缩率为 53.8%和 76.7%。保留胆囊与否，供体和受者的胆道和血管并发症无显著差异。
这些数据表明，对于符合解剖要求的供体，保留供体胆囊的肝移植物获取术是可行且安全的。保留的胆囊被评估为功能良好，并且在长期随访中，由于胆囊切除术引起的术后症状显著减少。
