Hybrid Procedure in Living Donor Liver Transplantation
Hybrid Procedure in Living Donor Liver Transplantation
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DOI：
10.1016/j.transproceed.2015.02.016
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发表时间：
2015-04-01
影响因子：
0.9
通讯作者：
Eguchi, S.
中科院分区：
文献类型：
--
作者：
Soyama, A.;Takatsuki, M.;Eguchi, S.
背景我们以前曾报道过一种混合手术，在活体肝移植（LDLT）中使用腹腔镜肝脏动员和随后的直视下肝切除术相结合。我们提出了这种混合程序的细节和程序的结果。1997年1月至2014年8月，在长崎大学医院进行了204例LDLT。其中，67例近期供体行混合供体肝切除术。供体行左半肝切除41例，右半肝切除25例，肝后段切除1例。首先，做一个8 cm剑突下中线切口;然后在气腹下通过中线切口用手辅助实现腹腔镜肝脏游离。此后，将切口延长至12 cm，用于右叶和后段移植物以及10 cm左叶移植物采集。在直视下，通过悬肝手法进行肝实质横断。LDLT受体的混合手术仅适用于选定的萎缩性肝硬化病例，这些病例无上腹部手术史、显著的腹膜后侧支血管或肝脏肥厚性改变（n = 29）。对于全肝切除和脾切除术，中线切口充分延伸。所有的混合供体肝切除术均在没有额外肋下切口的情况下完成。与传统开放手术相比，在失血量或手术时间方面没有观察到显著差异。所有供体均恢复到术前活动水平，与使用传统开放手术治疗的患者相比，伤口相关投诉较少。在接受混合手术治疗的受者中，与接受常规Mercedes-Benz型切口治疗的受者相比，未观察到临床相关缺陷。我们的混合手术在LDLT供体和受体中安全地进行，质量与传统开放手术相同。
Background. We have previously reported a hybrid procedure that uses a combination of laparoscopic mobilization of the liver and subsequent hepatectomy under direct vision in living donor liver transplantation (LDLT). We present the details of this hybrid procedure and the outcomes of the procedure.Methods. Between January 1997 and August 2014, 204 LDLTs were performed at Nagasaki University Hospital. Among them, 67 recent donors underwent hybrid donor hepatectomy. Forty-one donors underwent left hemihepatectomy, 25 underwent right hemihepatectomy, and 1 underwent posterior sectionectomy. First, an 8-cm subxiphoid midline incision was made; laparoscopic mobilization of the liver was then achieved with a hand-assist through the midline incision under the pneumoperitoneum. Thereafter, the incision was extended up to 12 cm for the right lobe and posterior sector graft and 10 cm left lobe graft procurement. Under direct vision, parenchymal transection was performed by means of the liver-hanging maneuver. The hybrid procedure for LDLT recipients was indicated only for selected cases with atrophic liver cirrhosis without a history of upper abdominal surgery, significant retroperitoneal collateral vessels, or hypertrophic change of the liver (n = 29). For total hepatectomy and splenectomy, the midline incision was sufficiently extended.Results. All of the hybrid donor hepatectomies were completed without an extra subcostal incision. No significant differences were observed in the blood loss or length of the operation compared with conventional open procedures. All of the donors have returned to their preoperative activity level, with fewer wound-related complaints compared with those treated with the use of the conventional open procedure. In recipients treated with the hybrid procedure, no clinically relevant drawbacks were observed compared with the recipients treated with a regular Mercedes-Benz-type incision.Conclusions. Our hybrid procedure was safely conducted with the same quality as the conventional open procedure in both LDLT donors and recipients.