摘要
目的 探讨精准肝脏外科理念在儿童活体肝移植供肝切取术中的临床价值.方法 回顾性分析2012年12月至2014年1月上海交通大学医学院附属仁济医院收治的58例儿童活体肝移植供者的临床资料.术前对供者行CT等检查,将二维影像学数据进行三维重建,评估供者肝内胆管和血管情况,并对肝左动脉和肝左静脉解剖结构进行分型,测算供者标准肝脏体积、拟切取肝脏体积和受者标准肝脏体积,模拟手术操作,制订手术方案.采取精准肝切除切取供肝.采用门诊和电话方式进行随访,随访时间截至2014年4月.结果 58例儿童活体肝移植供者术前CT血管造影检查示肝左动脉Ⅰ型28例、Ⅱ型10例、Ⅲ型20例、无Ⅳ型供者;肝左静脉Ⅰ型35例、Ⅱ型23例.三维重建预测拟切取肝脏体积为（243±65） mL.58例供者均成功完成供肝切取术,其中7例为左半肝切取,51例为肝左外叶切取.2例供者行胆囊切除.术中实际切取肝脏体积为（255±59） mL,拟切取肝脏体积平均误差率为4.94％.移植物质量与受者体质量比为3.3％±1.0％.手术时间为（260±89）min,术中出血量为（181±35）mL,仅1例供者术中输RBC 2 U.供者术后胃肠功能恢复时间为（2.0±1.1）d,术后拔除引流管时间为（3.0±1.2）d,术后住院时间为（7±3）d,出院时所有供者血清WBC、Hb、ALT、AST、TBil、DBil、AIb等指标水平正常.2例供者术后发生并发症,分别为切口少量渗血和脂肪液化,均经对症治疗后痊愈.58例儿童活体肝移植供者术后均获得随访,中位随访时间为8.7个月.供者恢复良好,随访期间无并发症发生.结论 精准肝脏外科理念应用于儿童活体肝移植供肝切取术,切取准确率高、供者肝功能损害小、术后并发症少、恢复快.
Objective To investigate the clinical value of the precision liver surgery in the liver graft procurement for pediatric living donor liver transplantation.Methods The clinical data of 58 living donors of left hepatic lobe graft who were admitted to the Renji Hospital of Shanghai Jiaotong University from December 2012 to January 2014 were retrospectively analyzed retrospectively from December 2012 to January 2014.All the donors donated voluntarily and gratuitously and were approved by the ethics committee of the hospital.All the donors received computed tomography （CT）,and the two dimensional data were converted to three dimensional images for evaluating the intrahepatic bile ducts and blood vessles,and the typs of the left hepatic arteries and veins were determined.The donor＇s liver graft volume was assessed by CT before operation.The standard liver volume of the donors and the recipients,and the volume of liver to be reseeted and the total liver volume were measured.A virtual surgery was conducted for designing the actual surgery.The liver graft was resected with the precision liver surgery technique.Patients were followed up by the out-patient examination and phone call till April 2014.Results The results of CT angiography confirmed that 28 donors were with type Ⅰ left hepatic artery,10 with type Ⅱ left hepatic artery and 20 with type Ⅲ left hepatic artery; 35 patients were with type Ⅰ left hepatic vein and 23 with type Ⅱ left hepatic vein.The left-lobe volume estimated by CT was （243 ± 65） mL.Liver graft procurement was successfully carried out on the 58 donors,including 7 left hemihepatectomy and 51 left lateral lobectomy.Two donors received cholecystectomy concomitantly.The actual volume of liver resected was （255 ±59） mL,and the error rate of the liver volume to be resected was 4.94%.The weight of the liver graft to the body weight of the recipient was 3.3% ± 1.0%.The operation time and the volume of blood loss were （260 ± 89） minutes and （181 ± 35）mL,respectively.One do
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2014年第10期806-810,共5页
Chinese Journal of Digestive Surgery
基金
上海市卫生局重点联合攻关项目（2013ZYJB0001）
上海市科委医学引导类基金（134119a9501）
关键词
肝移植
活体
儿童
精准肝脏外科
Liver transplantation,living donor
Child
Precision liver surgery
