探讨全腹腔镜活体供肝右半肝切取术的可行性及疗效。

回顾性分析2020年5月在新疆医科大学第一附属医院行全腹腔镜活体供肝右半肝切取术的1例供者和1例受者临床资料。供者和受者均签署知情同意书，符合医学伦理学规定。供者女，39岁，自愿为其亲妹捐献右半肝。实验室检查和腹部超声、CT等均未见异常，血管重建分析未见肝动脉、门静脉变异；MRCP检查结果示供体胆道变异，为Varotti分型3a型。受者女，37岁，术前诊断为原发性胆汁性肝硬化、慢加急性肝衰竭，术前综合评估符合肝移植手术指征。于2020年5月28日行全腹腔镜活体供肝右半肝切取术。

术前预估供者全肝体积为1 149 cm³，不带肝中静脉的右半肝体积为534 cm³，预留肝脏体积为615 cm³，占全肝体积的54%。移植物受体体重比（GRWR）为1.01%。手术时间465 min，术中出血量约300 ml，术中未输血。供肝实际重量610 g，GRWR 1.15%。供者术后第3天拔除引流管，肝功能恢复良好，未发生并发症，于术后第6天顺利出院。受者术后恢复可，肝功能逐渐好转，未发生移植相关并发症。

在熟练的腹腔镜肝切除技术和丰富的活体肝移植术经验的基础上，实施全腹腔镜活体供肝右半肝切取术安全、可行。

To evaluate the feasibility and efficacy of total laparoscopic living donor right hepatectomy.

Clinical data of 1 donor and 1 recipient who underwent total laparoscopic living donor right hepatectomy in the First Affiliated Hospital of Xinjiang Medical University in May 2020 were retrospectively analyzed. The informed consent of the donor and recipient was obtained and the local ethical committee approval was received. The female donor, aged 39 years, was willing to donate the right liver lobe to her biological sister. No abnormality was found by laboratory examination, abdominal ultrasound and CT scan. No variations of hepatic artery and portal vein were detected in vascular reconstruction. Biliary tract variation of the donor was found by MRCP, which was classified as Varotti type 3a. The female recipient, aged 37 years, was diagnosed with primary biliary cirrhosis and chronic combined with acute liver failure before operation. Preoperative comprehensive evaluation confirmed the indication of liver transplantation. On May 28, 2020, total laparoscopic living donor right hepatectomy was performed.

The estimated total liver volume of the donor was 1 149 cm³ before operation, the estimated volume of right lobe without middle hepatic vein was 534 cm³, and the reserved liver volume was 615 cm³, accounting for 54% of the total liver volume. The graft to recipient weight ratio (GRWR) was 1.01%. The operation time was 465 min, intraoperative blood loss was approximately 300 ml, and no blood transfusion was delivered during operation. The actual weight of donor liver was 610 g, and GRWR was 1.15%. The drainage tube of the donor was removed at postoperative 3 d, and the liver function recovered well without postoperative complications. The donor was discharged on the 6th day after operation. The recipient recovered well, and the liver function were gradually improved. No transplantation-related complications occurred.

It is safe and feasible to perform total laparoscopic living donor right hepatectomy base on experienced skills of laparoscopic hepatectomy and living donor liver transplantation.