摘要
目的探讨肝中静脉的切取对活体右半肝移植供者残肝淤血和再生的影响。方法本中心2008年8月至2009年8月实施的活体右半肝移植供者28例，其中不带肝中静脉右半肝切取的供体11例（A组），带肝中静脉右半肝切取的供体17例（B组）。术后2周行CT检查测量残肝的体积。比较两组供者Ⅳ段肝静脉与不同分型的术后早期残肝淤血和再生情况。结果本组供体有10例发现Ⅳ段淤血，均为残肝不含肝中静脉者（B组），其中7例为完全或大部分淤血，A组供者无1例出现肝脏淤血；两组相比差异有统计学意义（P=0．006）。B组供者中Ⅳ段肝静脉分型为I型者共有6例，Ⅳ段全部出现淤血且为完全淤血；而Ⅱ型中共有4例患者发生淤血，其中完全淤血1例，两型相比差异有统计学意义（P=0．035）。术后两周B组Ⅳ段体积为（186±72）ml，A组Ⅳ段体积为（302±85）ml，B组显著小于A组（P=0．005）。B组Ⅳ段再生比例显著小于A组（P=0．007）；I～Ⅲ段的再生比例B组显著大于A组（P=0．008）；而A、B组残肝再生差异无统计学意义（P=0．63）。结论带肝中静脉右半肝切除没有明显损害供体早期肝功能。残肝Ⅳ段有淤血发生，导致再生受到不利影响，但可通过Ⅱ、Ⅲ段再生代偿，整体残肝再生不受影响。
Objective To investigate the effect of living donor right liver graft transplantation （LDLT） with middle hepatic vein （MHV） on the early congestion and regeneration of the donor remnant liver. Methods Between August 2008 and August 2009,28 LDLT were performed with 11 LDLT without MHV （group A） and 17 LDLT with MHV （group B）. The donor operative time, intraoperative blood loss, postoperative hospital stay, bilirubin, INR, and ALT level were recorded in detail. We measured the volume of remnant liver by means of CT scan 2 weeks after operation and compare the degree of congestion and regeneration of the remnant liver between the two groups. Results There were 10 cases in group B and 0 cases in group A suffering from congestion at segment IV, and the difference was significant （P = 0. 006）. In group B, 6 cases in type I and 4 cases in type Ⅱ developed congestion at segment IV, and the difference was significant（P = 0. 035 ）. Two weeks post operation, the volume of segment IV in group B was smaller than in group A（P =0. 005）. The regeneration rate of segment 1V in group B was smaller than in group A （P = 0. 007）, on the contrary, the regeneration rate of segment I - Ill in group B was larger than in group A （P = 0. 008）. But the regeneration rate of remnant liver was the same in both groups （ P = 0. 63 ）. Conclusions The right lobe hemihepatectomy with MHV does not damage the early liver function of the donor significantly. The segment IV of the remnant liver suffered from congestion and impeded the regeneration, but was compensated by the regeneration of segments I - Ⅲ.
出处
《中华普通外科杂志》
CSCD
北大核心
2011年第10期807-810,共4页
Chinese Journal of General Surgery
基金
基金项目：天津市卫生局面上基金资助项目（09KY09）
关键词
活体供者
肝移植
淤血
再生
Living donor
Liver transplantation
Congestion
Regeneration
