中国实用外科杂志

中国实用外科杂志

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腹腔镜活体肝移植供肝切取技术要点及评价（附12例报告）

吴    泓，杨家印，魏永刚，黄纪伟，李    伟，李    波，曾    勇，严律南   

  1. 四川大学华西医院肝脏肝移植外科，四川成都610041
  • 出版日期:2017-05-01 发布日期:2017-04-28

  • Online:2017-05-01 Published:2017-04-28

摘要：

目的    探讨腹腔镜活体肝移植供肝切取手术的技术要点和应用前景。方法    回顾性分析2015年 9月至 2016年 10月四川大学华西医院肝脏肝移植外科12例腹腔镜下活体肝移植供肝切取术病人资料。分析12例供者及相应12例受者的手术及预后情况。结果    12例供者中，切取不包括肝中静脉的右半肝6例，左外叶3例，不包括肝中静脉的左半肝3例。术中失血量400（100～600 mL）。供者住院时间7（4～10 d）。所有供者术后均无并发症发生及围手术期死亡。12例受者术前移植物受体体重比（GRWR）为0.94%（0.54%～3.70%）。手术时间625（405～720 min）。术中失血量750（200～3000）mL。术后住院时间20（7～40）d。1例受者病人术后第7天发生消化道出血，保守治疗后出血停止。1例受者病人术后出现肺部感染，保守治疗后无效于术后第8天因呼吸衰竭死亡。其余受者病人术后顺利出院。结论    随着技术的不断发展和器械的不断改进，腹腔镜活体肝移植供肝切取将有广阔的应用前景。

关键词: 活体肝移植, 腹腔镜, 肝切除术, 预后

Abstract:

The application and surgical technique of laparoscopic hepatectomy in living donor liver transplantation：A report of 12 cases        WU Hong, YANG Jia-yin, WEI Yong-gang, et al. Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041,China
Corresponding author: ZENG Yong, E-mail：zengyong@medmail.com.cn
Abstract    Objective    To evaluate the application and surgical technique of laparoscopic hepatectomy in living donor liver transplantation (LDLT). Methods    The clinical data of 12 cases of laparoscopic hepatectomy in LDLT performed from September 2015 to October 2016 in Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University were analyzed retrospectively. The surgical outcomes and short-term prognosis of the donors (12 cases) and recipients (12 cases) were analyzed. Results    Among the 12 donors, right hemihepatectomy without middle hepatic vein was performed in 6 cases; left lateral lobectomy in 3 cases and left hemihepatectomy without middle hepatic vein in 3 cases. The median intraoperative blood loss was 400 mL (ranging from 100 to 600 mL). The median hospital stay of the donors was 7 days (ranging from 4 to 10 days). All donors had no postoperative complications and deaths. Among the 12 recipients, the median graft-recipient weight ratio (GRWR) was 0.94% (ranging from 0.54% to 3.70%). The median surgical duration was 625 min (ranging from 405 to 720 min). The median intraoperative blood loss of the recipients was 750 mL (ranging from 200 to 3000 mL). The median hospital stay of the donors was 20 days (ranging from 7 to 40 days). One case had gastrointestinal bleeding in postoperative day 7 and the bleeding stopped after conservative treatment. One case died from respiratory failure in postoperative day 8. The other recipients were discharged smoothly. Conclusion    With the improved surgical techniques and advanced laparoscopic instruments, it is believed that laparoscopic LDLT is a feasible technique and has a promising prospect.

Key words: living donor liver transplantation, laparoscopy, hepatectomy, prognosis