Left Lateral Segmentectomy for Pediatric Live-Donor Liver Transplantation: Special Attention to Segment IV Complications
Left Lateral Segmentectomy for Pediatric Live-Donor Liver Transplantation: Special Attention to Segment IV Complications
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儿童活体肝移植的左外侧肝段切除术：特别注意 IV 段并发症
DOI：
10.1097/tp.0b013e318183ed22
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发表时间：
2008
期刊：
影响因子：
6.2
通讯作者：
P. Chapchap
中科院分区：
文献类型：
--
作者：
J. Seda;A. Godoy;E. Carone;V. Pugliese;E. Fonseca;G. Porta;R. Pugliese;I. Miura;Vera Baggio;M. Kondo;P. Chapchap
背景。在活体肝移植的左侧肝段切除术中，IV 段的血管流入可能会受到影响。术中可见缺血区域，可能需要进一步切除 IV 段以防止坏死和脓肿形成。方法。从1995年7月到2007年2月，巴西圣保罗的A.C.Camargo医院和Sirio-Libanes医院连续进行了324例活体肝移植。在此期间移植了 211 个左侧节段。 204 个左侧节段捐献者的数据可用于此分析。结果。共有 108 名女性捐献者和 96 名男性捐献者。中位年龄为 29 岁（范围：16-48 岁）。中位随访时间为 2.2 年（范围：2 个月至 11.8 年）。重症监护病房住院时间中位数为 1 天（范围为 1-3 天），住院时间中位数为 5 天（范围为 4-47 天）。 39 名捐献者（19.1%）出现术后并发症。 107例（52.5%）因实质变色而需在初次手术过程中部分IV段切除。 10 名患者（4.9%）出现 IV 段坏死或脓肿，尽管其中 4 名患者在术中进行了 IVB 段切除。 IV 段坏死或脓肿显着增加住院时间和再入院次数，分别从 5.5±3.5 天增加到 8.4±3.7 天（P=0.012），从 194 例中的 6 例（3%）增加到 10 例中的 5 例（50%）（P=0.001）。结论。肝中段脓肿或坏死是左外段切除术后最常见的并发症（4.9%）。需要制定客观的术中策略来评估中肝段缺血，以识别和治疗高风险患者。
Background. During left lateral segmentectomy for live-donor liver transplant, the vascular inflow to segment IV can be compromised. An area of ischemia can be seen intraoperatively and further segment IV resection may be needed to prevent necrosis and abscess formation. Methods. From July 1995 to February 2007, 324 consecutive living donor liver transplantations were performed at Hospital A. C. Camargo and Hospital Sirio-Libanes, Sao Paulo, Brazil. Two hundred eleven left lateral segments were transplanted in this period. Data on 204 left lateral segments donors were available for this analysis. Results. There were 108 female and 96 male donors. Median age was 29 years (range, 16–48 years). Median follow-up time was 2.2 years (range, 2 months–11.8 years). Median intensive care unit stay was 1 day (range, 1–3 days), and median hospital stay was 5 days (range, 4–47 days). Postoperative complications were encountered in 39 donors (19.1%). Partial segment IV resection on the course of the primary surgery due to parenchyma discoloration was required in 107 cases (52.5%). Ten patients (4.9%) developed segment IV necrosis or abscesses, although four of them had had segment IVB resection intraoperatively. Segment IV necrosis or abscess significantly increased hospital stay and the number of readmissions, from 5.5±3.5 days to 8.4±3.7 days (P=0.012) and from 6 of 194 (3%) to 5 of 10 (50%) (P=0.001), respectively. Conclusions. Middle hepatic segment abscess or necrosis was the most frequent complication after left lateral segmentectomy (4.9%). Objective intraoperative strategies need to be developed to evaluate middle hepatic segment ischemia to identify and treat patients at higher risk.
影响因子：
9
作者：
TANAKA, K;UEMOTO, S;OZAWA, K
通讯作者：
OZAWA, K