成人活体肝移植71例报道.doc

***活体肝移植71例报道
【关键词】肝移植; 活体; ***
【Abstract】 Objective To investigate the method of securing donors and recipients during the initial procedure of adult-to-adult living donor liver transplantation (ALDLT). Methods The clinical data, preoperative assessment, surgical strategies and plications of 71 adult donors and recipients April 2007 to November 2007 iddle hepatic vein (MHV), 1 extended right lobe, 4 right lobes postoperative plications including 1 inal bleeding. No donor mortality occurred. Eighteen recipients had postoperative plications including 12 all-for-size syndrome. The perioperative mortality rate of recipients ent, optimal surgical strategy and postoperative care are extremely helpful to secure donors and recipients during the initial procedure of ALDLT.
【Key m以上的肝静脉均使用钛夹夹闭或结扎,5 mm以上的肝静脉移植肝侧需标记结扎留待重建,供者保留侧需6-0 Prolene线缝扎。胆管切断前需在拟定切线处挂显影线造影以确认切线位置准确无误,胆管切断后需仔细止血,自体保留端胆管残端用6-0 Prolene线缝合关闭,然后需再次造影确认胆道无狭窄或胆漏。在第一肝门和第二肝门之间肝后下腔静脉前方置带悬吊中线肝实质,仔细分离直至将左、右半肝完全分开。先后阻断供肝流入和流出道并予以切断,切下供肝。供肝迅速置于冰盆经门静脉灌注4 ℃乳酸林格氏液和Ul,胆管和肝动脉分别用4 ℃乳酸林格氏液和Ul冲洗。根据需要分别进行肝静脉成形(带肝中静脉右半肝需将肝右静脉和肝中静脉成形为1个开口)、架桥(Ⅴ段和Ⅷ段肝静脉)和胆管、门静脉成形。
受者手术:行保留下腔静脉病肝切除术,供肝植入时,先阻断肝上、下腔静脉,然后吻合肝静脉。如采用左半肝则根据供肝静脉开口的大小,将受者的肝左、中或左、中、右静脉完全劈开成形,重建流出道。如采用右半肝,则先吻合供、受者的肝右静脉,然后将直径超过5 mm的肝中静脉V、Ⅷ段属支搭桥吻合到肝中或肝左、中静脉共干上,搭桥采用冷冻的尸体血管。肝右后下静脉则直接吻合到下腔静脉上。供者门静脉左或右分支与受者门静脉主干或左右分支行端端吻合,4例右半肝移植物门静脉右前支和右后支分别开口,2例经成形为1个开口后吻合,另2例则分别将供肝门静脉右前支和右后支与受者的门