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中华肝脏外科手术学电子杂志 ›› 2021, Vol. 10 ›› Issue (05): 514 -518. doi: 10.3877/cma.j.issn.2095-3232.2021.05.018

所属专题: 经典病例 文献资源库

临床研究 上一篇    下一篇

全腹腔镜活体供肝右半肝切取术一例并文献复习
李涛 1, 吐尔洪江·吐逊 1, 沙地克·阿帕尔 1, 白磊 1, 曹峻 1, 何翼彪 1, 王智鹏 1, 赵晋明 1 , ( )   
  1. 1. 830054 乌鲁木齐,新疆医科大学第一附属医院消化血管外科中心肝脏·腹腔镜外科
  • 收稿日期:2021-06-08 出版日期:2021-08-17
  • 通信作者: 赵晋明
  • 基金资助:
    国家自然科学基金(81560329); 新疆维吾尔自治区科技厅重点实验室开放课题项目(2018D03002); 新疆维吾尔自治区天山青年计划博士科技人才培养项目(2017Q094); 新疆医科大学省部共建中亚高发病成因与防治国家重点实验室开放课题项目(SKL-HIDCA-2017-Y2)

Total laparoscopic living donor right hepatectomy: report of one case and literature review

Tao Li 1, Tuxun Tuerhongjiang· 1, Apaer Shadike· 1, Lei Bai 1, Jun Cao 1, Yibiao He 1, Zhipeng Wang 1, Jinming Zhao 1 , ( )   

  1. 1. Department of Digestive Vascular Surgery Center, Liver and Laparoscopic Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
  • Received:2021-06-08 Published:2021-08-17
  • Corresponding author: Jinming Zhao
目的

探讨全腹腔镜活体供肝右半肝切取术的可行性及疗效。

方法

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。

结果

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。

结论

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。

Objective

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

Methods

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.

Results

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.

Conclusions

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.

图1 腹腔镜活体供肝获取手术Trocar布局示意图
图2 腹腔镜活体肝移植供肝右半肝获取手术示意图
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