SURGICAL TECHNIQUES AND INNOVATIONS IN LIVING RELATED LIVER-TRANSPLANTATION
SURGICAL TECHNIQUES AND INNOVATIONS IN LIVING RELATED LIVER-TRANSPLANTATION
复制标题
DOI：
10.1097/00000658-199301000-00014
复制
发表时间：
1993-01-01
影响因子：
9
通讯作者：
OZAWA, K
中科院分区：
文献类型：
--
作者：
TANAKA, K;UEMOTO, S;OZAWA, K
作者于1990年6月至1992年5月在征得患儿父母的知情同意和京都大学伦理委员会的批准下，成功地为33例儿童（男15例，女18例，年龄7个月至15岁）进行了活体肝移植（LRLT）。手术前，6名儿童需要重症监护，另外14名住院，13名回家。供体（12名父亲和21名母亲）仅根据ABO血型和计算机断层扫描确定的移植物/受体大小匹配从受体的父母中选择。使用超声吸引器和双极电烙器进行移植物的获取，不夹闭血管，也不操作移植物。所有供体随后肝功能正常，恢复正常生活。移植肝左外段16例，左叶16例，右叶1例。部分肝移植到接受者谁接受了全肝切除术，保留下腔静脉使用血管侧夹。33例受者中有27例存活良好，具有正常的肝功能。择期手术患者的生存率为89%（24/27），急诊手术患者的生存率为50%（3/6）。其他6例移植物功能正常，但死于肝外并发症。所有病例的移植物并发症都很小。其中2例发生3次肝静脉狭窄，经球囊扩张成功治疗。在门静脉硬化的病例中，在经历了一例血管移植物血栓形成后，作者将移植物的门静脉缝合到脾静脉和上级肠系膜静脉的汇合处，而没有血管移植物。在最初的7例接受肝动脉吻合的患者中，有1例发生肝动脉血栓形成，采用显微外科手术进行肝动脉重建。此后未发生血栓形成。目前LRLT的结果表明，在LRLT手术的每个阶段对手术参与者进行细致的管理对于成功的结果至关重要。活体相关肝移植是解决儿科肝移植中移植物短缺的一个有希望的选择，并且可以被视为补充尸体捐献的一种独立方式。
The authors successfully performed a series of 33 living related liver transplantations (LRLT) on children (15 males and 18 females, ranging from 7 months to 15 years of age) from June 1990 to May 1992, with the informed consent of their parents and the approval of the Ethics Committee of Kyoto University. Before operation, six of the children required intensive care, another 14 were hospitalized, and 13 were homebound. Donors (12 paternal and 21 maternal) were selected solely from the parents of the recipients on the basis of ABO blood group and graft/recipient size matching determined by computed tomography scanning. Procurement of graft was performed using ultrasonic aspirator and bipolar electrocautery without blood vessel clamping and without graft manipulation. All donors subsequently had normal liver function and returned to normal life. The left lateral segment (1 6 cases), left lobe (1 6 cases), or right lobe (one case) were used as grafts. The partial liver graft was transplanted into the recipient who underwent total hepatectomy with preservation of the inferior vena cava using a vascular side clamp. Twenty-seven of 33 recipients are alive and well with the original graft and have normal liver function. The patient survival rate was 89% (24/27) in elective cases and 50% (3/6) in emergent cases. The other six recipients had functioning grafts but died of extrahepatic complications. Complications of the graft were minimal in all cases. Hepatic vein stenosis, which occurred three times in two cases, was successfully treated by balloon dilatation. In cases with sclerotic portal vein, the authors anastomosed the portal vein of the graft to the confluence of the splenic vein and the superior mesenteric vein without a vascular graft, after experiencing a case of vascular graft thrombosis. After hepatic artery thrombosis occurred in one of the initial seven recipients whose arterial anastomosis was done with surgical loupe, microsurgery was introduced for hepatic artery reconstruction. There has been no occurrence of thrombosis since then. The current results with LRLT suggested that the meticulous management of surgical actors at each stage of the LRLT procedure is crucial for successful outcome. Living related liver transplantation is a promising option for resolving the graft shortage in pediatric liver transplantation and may be regarded as an independent modality to supplement cadaver donation.