Pure Laparoscopic Full‐Left Living Donor Hepatectomy for Calculated Small‐for‐Size LDLT in Adults: Proof of Concept
Pure Laparoscopic Full‐Left Living Donor Hepatectomy for Calculated Small‐for‐Size LDLT in Adults: Proof of Concept
复制标题
纯腹腔镜全左活体肝切除术用于成人计算的小尺寸 LDLT：概念验证
DOI：
10.1111/ajt.12362
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发表时间：
2013
影响因子：
8.8
通讯作者：
Xavier Rogiers
中科院分区：
文献类型：
--
作者：
Roberto Troisi;M. Wójcicki;Federico Tomassini;Philippe Houtmeyers;A. Vanlander;F. Berrevoet;Peter Smeets;H. Vlierberghe;Xavier Rogiers
成人对成人活体肝移植(A2ALDLT)是一种公认的终末期肝病的治疗模式。右叶移植物通常是首选的，因为移植物体积较大，这降低了小体积综合征的风险。然而，与右肝切除术相比，供体左肝切除术的发病率较低。腹腔镜供肝切除术(LDH)已被认为几乎完全用于儿科移植。本文报告了四位供者在计算小体积A2ALDLT时行腹腔镜左肝移植手术的结果。在所有的受者中，移植物与受者的体重比为0.8。门静脉平均血流量为190 ± 56 m L/m in/100 g，门静脉平均血流量13 ± 1.4 mm/Hg，肝动脉平均血流量109 ± 19 m L/m in。术后未出现供体早期并发症。一例移植肝因肝内脓肿丢失。一位供者在4个月后用Roux-en-Y环治疗了无症状的右后导管狭窄。结果表明，完全左叶的LDH是可行的。腰椎间盘突出症是一种要求非常高的手术，有可能降低供者的发病率。这一程序的标准化，使越来越多的有经验的腹腔镜肝脏外科医生能够使用它，可能有助于在西方世界重新引起对A2ALDLT的兴趣。
Adult‐to‐adult living donor liver transplantation (A2ALDLT) is an accepted mode of treatment for end‐stage liver disease. Right‐lobe grafts have usually been preferred in view of the higher graft volume, which lowers the risk of a small‐for‐size syndrome. However, donor left hepatectomy is associated with less morbidity than when it is compared to right hepatectomy. Laparoscopic donor hepatectomy (LDH) has been considered almost exclusively in pediatric transplantation. The results of laparoscopic left‐liver graft procurement for calculated small‐for‐size A2ALDLT in four donors are presented. The graft‐to‐recipient body weight ratio was <0.8 in all recipients. The mean portal vein flow and the pressure and hepatic artery flows were measured at 190 ± 56 mL/min/100 g, 13 ± 1.4 mm/Hg and 109 ± 19 mL/min, respectively. No early postoperative donor complications were recorded. One graft was lost due to intrahepatic abscesses. Asymptomatic stenosis of a right posterior duct was treated with a Roux‐en‐Y loop 4 months later in one donor. We show that LDH of the full‐left lobe is feasible. LDH is a very demanding operation, potentially decreasing donor morbidity. Standardization of this procedure, making it accessible to the growing number of experienced laparoscopic liver surgeons, could help renewing the interest for A2ALDLT in the Western world.