Total laparoscopic living donor right hepatectomy
Total laparoscopic living donor right hepatectomy
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DOI：
10.1007/s00464-014-3649-9
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发表时间：
2015-01-01
影响因子：
3.1
通讯作者：
Lee, Woohyung
中科院分区：
文献类型：
--
作者：
Han, Ho-Seong;Cho, Jai Young;Lee, Woohyung
右叶活体肝移植（LDLT）是成人间LDLT的主要形式。因此，年轻捐赠者的美容和功能需求正在增加。我们在世界上首次成功地在成人活体供体上进行了全腹腔镜右半肝切除术（LDRH），并在两例年轻供体上进行了全LDRH。经耻骨上横切口取出改良扩大右肝移植物（右肝包括所有肝中静脉分支），充分游离右肝后，行肝门部解剖。首先，在胆总管外侧牵开的情况下分离右门静脉。肝右动脉小心分离，无损伤。在使用Bulldog夹短暂夹闭肝脏右侧肝动脉和门静脉的过程中，绘制精确的横断线。沿肝中静脉右侧沿着仔细进行解剖，直至肝中静脉起点，直至暴露肝门板。精细解剖前段静脉分支（V5和V8），并使用人工血管移植物重建。经耻骨上切口取出保留肝中静脉分支的改良延长右移植物。供、受者均无并发症。供体术后住院时间分别为10和8天。经1年以上随访，供受者生活良好，肝功能正常，部分成年供者完全LDRH可行。如果这一程序将更加标准化，那么全LDRH将是成人LDLT的新选择，它满足了供体的需求，并减少了受体的内疚感[1-5]。
Right lobe living donor liver transplantation (LDLT) is the predominant form of adult-to-adult LDLT. Accordingly, cosmetic and functional demand by young donors is increasing. We developed the world first total laparoscopic donor right hepatectomy (LDRH) in adult living donors.Total LDRH was performed in two young donors without vascular clamping. Modified extended right graft (right liver including all the middle hepatic vein branches) was retrieved from suprapubic transverse incision.After full mobilization of right liver, hilar dissection was done. First, right portal vein was isolated under retracting common bile duct laterally. Right hepatic artery was cautiously dissected and isolated without injuring. An exact transection line was drawn during transient clamping of the hepatic artery and portal vein on the right side of the liver using bulldog clamp. Dissection was meticulously performed along the right side of the middle hepatic vein until the origin of middle hepatic vein until exposure of the hilar plate. Anterior section vein branches (V5 and V8) were finely dissected and were reconstructed using an artificial vascular graft. A modified extended right graft with preservation of the middle hepatic vein branches was extracted through the suprapubic incision. There was no complication in both donors and recipients. Postoperative hospital stay of donors was 10 and 8 days, respectively. After follow-up of more than 1 year, all donors and recipients live well with normal liver function.Total LDRH was feasible in selected adult donors. If this procedure will be more standardized, then total LDRH will be new option for adult LDLT, which meets demand by donors and diminish guilty feeling by recipients [1-5].