【摘要】 目的探讨全腹腔镜肝切除术在左外叶活体肝移植供肝切取中的应用价值。方法回顾性分析2016年10月至2016年11月复旦大学附属华山医院行全腹腔镜活体左外叶供肝切取的2例供者临床资料。例1供者女,27岁;受者诊断为先天性胆道闭锁;供受者关系为母子关系,预计移植物重量与受者体重比(GRWR)为3.2%。例2供者男,26岁;受者诊断为先天性胆汁酸合成障碍;供受者关系为父子关系,预计GRWR为2.1%。2例供者均签署知情同意书,符合医学伦理学规定。2例供者均采用全腹腔镜活体左外叶供肝切取,离断肝左动脉、门静脉左支和肝左静脉,耻骨上方小切口取出肝脏标本。结果 2例供者均手术成功。手术时间分别为190、210 min,术中出血量分别为100、60 ml,均未输血。实际GRWR分别为3.1%、1.8%。两例供者术后肝功能恢复顺利,未见胆漏、伤口愈合不良等并发症,术后1周出院,随访至投稿日期未见异常。受者肝功能恢复顺利,2周内基本恢复正常,随访未见明显移植物相关并发症。结论全腹腔镜活体左外叶供肝切取术能有效减轻供体损伤,且对移植物无不良影响,是安全、可行的供肝切取术式。更多还原

【Abstract】 Objective To investigate the application value of total laparoscopic hepatectomy in donor live procurement of left lateral living donor liver transplantation. Methods Clinical data of two donors who underwent total laparoscopic living donor liver procurement of left lateral lobe in Huashan Hospital affliated to Fudan University between October 2016 and November 2016 were retrospectively analyzed. Case 1, the donor was a 27-year-old female, and the recipient was diagnosed with congenital biliary atresia. The donor and the recipient were in mother-child relationship. The predicted graft recipient weight ratio(GRWR) was 3.2%. Case 2, the donor was a 26-year-old male, and the recipient was diagnosed with congenital bile acid synthesis defect. The donor and recipient were in father-child relationship. The predicted GRWR was 2.1%. The informed consents of both donors were obtained and the local ethical committee approval was received. Both donors underwent total laparoscopic living donor liver procurement of left lateral lobe. The left hepatic artery, left portal vein and left hepatic vein were dissected and cut, and the liver specimen was collected via the small suprapubic incision. Results The surgery was successfully performed in both donors. The operation time was respectively 190 and 210 min. The intraoperative blood loss was respectively 100 and 60 ml. No blood transfusion was performed intraoperatively. The actual GRWR was respectively 3.1% and 1.8%. The postoperative liver function of both donors recovered smoothly, and no bile leakage, poor wound healing or other postoperative complications were observed. They were discharged fromhospital at postoperative 1 week and were followed up, and no abnormality was observed in the donors till the manuscript submission date. The liver function of the recipients recovered smoothly and mainly returned to normal within 2 weeks. No obvious graft-related complications were observed during the follow-up. Conclusions Total laparoscopic living donor liver procurement of left lateral lobe can effectively alleviate the injury of the donors and has no adverse effects on the liver graft, which is a safe and feasible technique for donor liver procurement.更多还原