Makuuchi M, Kawasaki S, Noguchi T, Hashikura Y, Matsunami H, Hayashi K, Harada H, Kakazu T, Takayama T, Kawarasaki H
First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Surgery. 1993 Apr;113(4):395-402.
An essential prerequisite for living related partial liver transplantation is to perform donor hepatectomy with minimal risk while preserving graft viability. This article describes a safe method of donor hepatectomy that was used for five patients who underwent living related liver transplantation.
Liver parenchymal transection was performed by the selective vascular occlusion technique in four patients, and interruption of the blood supply to the left medial segment was carried out along the right side of the umbilical portion before parenchymal division in the other patient.
These procedures resulted in insignificant intraoperative blood loss, for which no banked blood or blood derivatives were transfused. The postoperative course for each of the five donors was uneventful, and excellent graft viability was verified by the fact that the five recipients showed a good immediate postoperative course without marked increases in the serum activities of liver enzymes.
We believe that the operative risk of living related donor hepatectomy is minimal if it is performed by experienced liver surgeons with the present procedures.
亲属活体部分肝移植的一个基本前提是在保留移植物活力的同时,以最小的风险进行供体肝切除术。本文描述了一种用于5例接受亲属活体肝移植患者的供体肝切除术的安全方法。
4例患者采用选择性血管阻断技术进行肝实质离断,另1例患者在实质离断前沿脐部右侧进行左内侧段血供阻断。
这些操作导致术中失血极少,无需输注库存血或血液制品。5例供体的术后过程均顺利,5例受体术后即刻过程良好,肝酶血清活性无明显升高,证实移植物活力良好。
我们认为,如果由经验丰富的肝脏外科医生采用目前的手术方法进行亲属活体供体肝切除术,手术风险极小。