【作者】 张玮晔；

【导师】 沈中阳；

【作者基本信息】 天津医科大学 ， 外科学， 2008， 硕士

【摘要】 【目的】研究是否保留肝中静脉对活体肝移植供体的影响,为保障供体的安全性奠定理论基础,并且为今后临床工作提供参考。【方法】回顾性分析我院活体肝移植供者(右半供肝)30例,按照是否保留肝中静脉分为2组。A组为供肝带肝中静脉组(n=15),B组为供肝不带肝中静脉组(n=15),两组间一般特征均无统计学差异。两足供者行活体肝移植右半供肝切除术,按照我中心现行肝中静脉分配原则,A组肝中静脉保留在供肝侧,B组肝中静脉保留在供者侧。我们收集并比较了两组患者的数据包括:CT测量肝脏体积、右半肝体积、GRWR、手术时间、失血量、术后腹水量、并发症发生情况、生存率等;我们还测量了供肝实际重量;术中乳酸峰值;术后1d,3d,5d,7d,9d,11d肝功能;B超监测肝切除前后肝动脉、门静脉血流变化。【结果】(1)CT测量供体全肝体积A组平均1274.79±144.60mm~3,B组平均1406.56±186.76 mm~3,两组间有统计学差异。我们还发现两组间有统计学差异的数据是:CT测量右半肝体积。GRWR、CT测右半肝体积/受体估计肝重两组间有显著性差异。而术中测量实际供肝体积两组间无统计学差异。(2)两组供者术中总手术时间、肝切除时间、失血量均无统计学差异。两组肝切除后术中乳酸峰值分别为3.72±0.38mmol/L及3.16±0.71mmol/L,两组相比有统计学差异,A组高于B组,P＜0.05。(3)根据术中B超监测,切肝后,左肝动脉流速A组高于B组;切肝后,门脉左支流速A组高于B组。(4)术后情况:两组供者腹水量、胆红素峰值、ALT、AST、ALB水平在术后早期均有统计学差异。两组FIB在术后1d有统计学差异,B组略高于A组,P＜0.05,但3d后再无统计学差异。两组供者的差异在术后两周左右时间均消失。两组患者术后均未出现胆瘘、出血、血栓等相关并发症。两组患者术后随访3月-1年,均健康存活,未出现术后并发症。【结论】(1)本实验证实,按照我中心现行肝中静脉分配原则,是否保留肝中静脉对供者安全性无明显影响。(2)对于供肝保留肝中静脉供者,术后肝功能恢复较慢,腹水减少速度较慢,保留腹引时间偏长,FIB较低,应该注意及时对症处理。更多还原

【Abstract】 【Objective】The research about the influence to donors in right lobe donator LDLT with or without middle hepatic vein,find the theoretical basis for protect the safety of the donor and provide reference for our future clinical work.【Method】30 donors were divided into two groups according to the position of MHV when they donation their right lobe.Group A(n=15)with their MHV and group B(n=15)without.There are no significant statistical difference in the character of these two groups.After the donors were performed right lobe hepatectomy for donation.We collect and compare the data include:whole liver volume,right lobe volum,GRWR,operation time,blood loss volume,ascites volume of postoperative, complication and survival rate.We still measured actual volume,the peak value of lactic acid,liver function of 1,3,5,7,9,11 days postoperation.And we overview the blood flow of HA,PV.【Results】(1)CT measured total hepatic volume in group A is 1274.79±144.60mm3 and 1406.56±186.76 mm3 in group B;the two groups have statistics differences,we still found statistical difference of two groups in CT measured right lobe volume and significant statistics differences in GRWR,CT measured right liver volume/receptor estimated liver volume.The actual volume of graft we test during operation has not statistical difference.(2)There are no significant difference in total operation time,liver resection time and blood loss After graft be removed the lactate peak during operation were 3.72±0.38mmol/L and 3.16±0.71mmol/L,there is a significant difference between the two groups.(3)According to ultrasound during-operation the group A faster than group B of the left hepatic artery blood flow speed,Left branch of portal vein flow rate after graft removed.(4)We found some significant statistics differences of ascites,drainage volume,total bilirubin,ALT,AST and ALB level in the ealy stage after operation.We only found statistics differences of FIB level at first day after operation and after that there is no statistics differences between two groups.However,almost all indicators between the two groups difference disappeared in about two weeks after operation.There are no biliary fistula, bleeding,thrombosis,and other related complications in all donors.After 3 month～1 year follow up does not appear postoperative complications.【Conclusion】(1)This experiment confirmed,according to my current center in the vein of liver allocation principle,whether to retain in the vein of the liver donor had no effect on security.(2)The donor hepatic vein for reservations,slower recovery after operation,ascites reduced slower,with reservations abdominal partial long time, FIB lower,we should pay attention to treatment in time.更多还原