摘要
目的 探讨在活体肝移植术中受体保留肝后下腔静脉切除全肝的手术技巧。方法 2 0 0 1年 1月至 2 0 0 2年 2月 ,我院行活体肝移植 1 1例 ,其中 Wilson’s病 1 0例 ,暴发性肝炎、肝功能衰竭 1例。均不使用静脉转流泵 ,行保留肝后下腔静脉的全肝切除术。技术要点 :在不阻断腔静脉血流的情况下解剖第三肝门 ,逐一缝扎或结扎、切断肝短静脉 ;使全肝切除前仅有门静脉及肝静脉与受体相连 ,待新肝植入时切除病肝 ,使受体无肝期尽量短。结果 手术均获得成功 ,病肝切除时间为 4 .8± 1 .7小时 ,病肝切除术中出血量平均为 35 0± 1 90 m l;1 0例受体术后 2～ 4周 AL T、AST、血清总胆红素、直接胆红素和血清白蛋白等均恢复正常。 1例术后第 72天死于严重的排斥反应。结论 肝移植受体一般患有长期肝硬化、门静脉高压症 ,病肝切除既要保留必要的管道 ,又要尽量减少出血 ,手术过程十分复杂 。
Objective To report our experience on whole hepatectomy of recipients with preservation of the inferior vena cava in living donor liver transplantation(LDLT).Methods From Jan 2001 to Feb 2002, 11cases of LDLTs were performed in our department. Of all 11 LDLTs, the cases of liver cirrhosis were Wilson's disease in 10 patients and fulminant hepatitis with liver function failure in 1 patient. The whole hepatectomy of recipients were performed without using venovenous bypass. The keypoints of the technique: the third liver hilum was dissected without blockage of cava, and hepatic short veins (the third porta hepatis) should be treated carefully. The ill liver links to recipient only with portal vein and hepatic vein before the whole hepatectomy in order to keep the time without liver as shorter as possible.Results Mean time of native hepatectomy for the recipient was 4.8±1.7 hours,and blood loss was 350±190ml in average. 10 recipients were well with normal liver function 2~4 weeks postoperatively, and one recipient died of serious rejection on the 72th day postoperatively.Conclusion Due to severe portal hypertension and liver cirrhosis, whole hepatectomy of recipients with preservation of the inferior vena cava was complex while conserving essential vessel and reducing blood loss in living donor liver transplantation(LDLT). Perfect technique could help to achieve success of trnsplantation.
出处
《肝胆外科杂志》
2003年第3期181-183,共3页
Journal of Hepatobiliary Surgery
基金
江苏省人民政府重点课题资助项目 ( BJ980 2 5 )
江苏省医学重点学科 (肝脏外科 )基金资助
关键词
肝移植
活体
肝切除
liver transplantation
living donor
hepatectomy
