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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2024, Vol. 13 ›› Issue (05) : 593 -601. doi: 10.3877/cma.j.issn.2095-3232.2024.05.001

指南与共识

劈离式供肝儿童肝移植中国临床操作指南
中华医学会器官移植学分会1, 中华医学会外科学分会外科手术学学组1, 中华医学会外科学分会移植学组1, 华南劈离式肝移植联盟1   
  1. 1. 510630　广州，中山大学附属第三医院肝脏外科暨肝移植中心　中山大学器官移植研究所　广东省肝脏疾病研究重点实验室　广东省移植医学工程实验室
  • 收稿日期:2024-06-26 出版日期:2024-10-10
  • 基金资助:
    国家重点研发计划项目(2017YFA0104304); 国家自然科学基金(81972286，82073171); 广东省自然科学基金(2020A1515010574，2020A1515010302); 广东省科技计划项目(2019B020236003，2020B1212060019)

Chinese Clinical Practice Guidelines on Split Liver Transplantation in Children

Chinese Society of Organ Transplantation of Chinese Medical Association, Surgery Group of Chinese Society of Surgery of Chinese Medical Association, Transplantation Group of Chinese Society of Surgery of Chinese Medical Association, South China Alliance of Split Liver Transplantation   

  • Received:2024-06-26 Published:2024-10-10
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中华医学会器官移植学分会, 中华医学会外科学分会外科手术学学组, 中华医学会外科学分会移植学组, 华南劈离式肝移植联盟. 劈离式供肝儿童肝移植中国临床操作指南[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 593-601.

Chinese Society of Organ Transplantation of Chinese Medical Association, Surgery Group of Chinese Society of Surgery of Chinese Medical Association, Transplantation Group of Chinese Society of Surgery of Chinese Medical Association, South China Alliance of Split Liver Transplantation. Chinese Clinical Practice Guidelines on Split Liver Transplantation in Children[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(05): 593-601.

肝移植是治疗儿童终末期肝病的有效手段，疗效确切。劈离式肝移植能有效扩大儿童供肝来源，劈离式供肝儿童肝移植具有特殊临床特点和规律，建立劈离式供肝儿童肝移植技术操作规范对提高疗效具有重要意义。本文从供者和供肝评估、供受体匹配、供肝管道的分割与重建方面形成劈离式供肝儿童肝移植临床操作指南，旨在规范劈离式供肝儿童肝移植的技术流程，优化手术细节，降低并发症发生率，进而促进我国劈离式供肝儿童肝移植快速发展。

关键词: 劈离式肝移植, 儿童, 肝移植, 指南

Liver transplantation is an effective treatment for end-stage liver disease in children, and its clinical efficacy has been validated. Split liver transplantation can effectively expand the donor liver pool for children. Split liver transplantation for children has specific clinical characteristics and principles. Establishing technical operation specifications for pediatric split liver transplantation plays a significant role in improving clinical efficacy. In this article, clinical practice guidelines on pediatric split liver transplantation was established in the aspect of donor and donor liver evaluation, donor-recipient matching, and ductal segmentation and reconstruction of donor liver, aiming to standardize the technical process, optimize surgical procedures, reduce the incidence of complications of split liver transplantation for children, further promoting rapid development of pediatric split liver transplantation in China.

Key words: Split liver transplantation, Children, Liver transplantation, Guideline
表1 儿童SLT供者的一般要求
指标 参考值范围
年龄 <50岁
BMI <26 kg/m2
ICU住院时间 <5 d
升压药 血流动力学稳定或低剂量升压药
肝脏脂肪变性比例 <10%
AST/ALT <3倍正常上限
总胆红素 <2倍正常上限
GGT <50 U/L
血清钠 <160 mmol/L
预计冷缺血时间 <10 h
图1 常见的门静脉分型[35]注：1为门静脉主干，2为门静脉右支，3为门静脉左支，4为门静脉右后支，5为门静脉右前支，6为门静脉右后上支，7为门静脉右后下支
图2 常见的肝左静脉变异类型[35]注：LHV、RHV、MHV分别为肝左静脉、肝右静脉、肝中静脉
图3 常见的胆道分型[35]注：CHD为胆总管，L为左肝管，R为右肝管，RA为右前支，RP为右后支
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