Live Donor Partial Hepatectomy for Liver Transplantation: Is There a Learning Curve?
Live Donor Partial Hepatectomy for Liver Transplantation: Is There a Learning Curve?
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活体肝部分切除术进行肝移植：有学习曲线吗？
DOI：
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发表时间：
2010
影响因子：
0.7
通讯作者：
M. Hertl
中科院分区：
文献类型：
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作者：
Reza F. Saidi;N. Elias;D. Ko;T. Kawai;J. Markmann;Sandy Feng;Cosimi Ab;M. Hertl
背景：供体安全是活体肝移植（LDLT）的首要任务。目的：确定 1997 年 1 月至 2007 年 5 月在麻省总医院接受供体肝切除术的活体肝脏捐献者的特征和结果。方法：1997年1月至2007年5月期间，30名患者在我院接受了LDLT。结果：移植物类型为右叶（5-8 段）14 例，左叶（2-4 段）4 例，左侧叶（2 和 3 段）12 例。捐赠者的平均年龄为 36 岁（范围：26-57）岁。平均随访时间为 48 个月（范围：18-120）个月。没有发生死亡事件。总体而言，8 名患者 (26.6%) 经历了总共 14 种术后并发症。根据移植物类型的供体并发症如下：左侧叶（16.7%）、左叶（25%）和右叶（35.7%）。经历分为两个时期：1997-2001年（n=15）和2002-2007年（n=15）。两个时期的总体并发症发生率分别为 40% 和 13.3% (p<0.001)。 Ⅲ级并发症的发生率也显着下降； 66.7% 对比 33.3% (p<0.01)。结论：活体肝部分切除术的学习曲线大约为 15 例。这种学习曲线不仅限于执行手术的外科医生，还涉及患者护理的各个方面。
Background: Donor safety is the first priority in living donor liver transplantation (LDLT). Objective: To determine the characteristics and outcome of live liver donors who underwent donor hepatectomy from January, 1997 to May, 2007 at Massachusetts General Hospital. Methods: 30 patients underwent LDLT between January, 1997 and May, 2007 at our institution. Results: The type of graft was the right lobe (segments 5-8) in 14, left lobe (segments 2-4) in 4, and left lateral sector (segments 2 and 3) in 12 patients. The mean donor age was 36 (range: 26-57) years. The mean follow-up was 48 (range: 18-120) months. No deaths occurred. Overall, 8 (26.6%) patients experienced a total of 14 post-operative complications. Donor complications based on graft type were as follows: left lateral sector (16.7%), left lobe (25%), and right lobe (35.7%). The experience was divided into two periods 1997-2001 (n=15) and 2002-2007 (n=15). Overall complications during 2 periods were 40% and 13.3%, respectively (p<0.001). The incidence of grade III complication also significantly decreased; 66.7% vs 33.3% (p<0.01). Conclusion: Partial hepatectomy in living donors has a learning curve which appears to be approximately 15 cases. This learning curve is not restricted to the surgeons performing the procedure but involves all aspects of patient care.