摘要目的 总结在体劈离式肝移植的临床经验.方法 回顾性分析2例中国一类心脏死亡器官捐赠(DCD)供者接受供肝在体劈离手术,并将劈离后的供肝移植给4例终末期肝病患者的临床资料.供肝的劈离手术中,在保证供者循环稳定的情况下使用超声吸引刀劈离肝实质,离体劈离肝脏血管和胆道,并对供肝进行修整.供者例1的全肝质量为1800 g,劈离成右三叶供肝和左外叶供肝,右三叶供肝移植给1例成人受者,左外叶供肝经减体积后移植给1例儿童受者.供者例2的全肝质量达2100 g,在体劈离成左右半肝,分别移植给2例成人受者.结果 在体劈离肝实质的手术耗时分别为1h和45 min,离体劈离肝血管和胆道的耗时分别为30 min和40 min.供肝热缺血时间均为0 min,冷缺血时间为120～360 min,移植肝质量与受者体质量比(GRWR)为1.5％～2.2％.肝移植后,1例成人受者出现门静脉血栓形成,经手术取尽门静脉血栓后,行门静脉-腔静脉搭桥,术后早期出现肝性脑病症状,经内科治疗后好转.肝移植后4例受者均恢复顺利,随访期间移植肝功能正常,均未发生排斥反应和感染并发症.结论 对于中国一类供者,实施在体劈离式肝移植是安全可行的,此项术式有望成为扩展供肝来源的重要途径,详细的术前评估技术和精细的手术操作是保证肝移植顺利进行的关键.

abstractsObjective To summarize the experience of in situ splitting liver transplantation in two cases of type 1 Chinese DCD.Method The livers in two cases of type 1 Chinese DCD were splitted in situ.The liver in the case one was splitted to one adult and one pediatric recipients,and the liver in the case two was donated to two adult recipients.The clinical data were studied retrospectively.Result In both of the procedure,hepatic parenchyma was splitted with CUSA when the donors were maintained with stable hemadymics.Vessels and biliary structures were splitted on back table.The first liver graft was splitted into right triple-lobe graft (1500 g) and left lateral lobe (200 g),and the later was reduced size to a monosegrnental graft (150 g).The second liver graft was splitted into right (1160 g) and left lobe graft (950 g) to two adult recipients.The in situ splitting duration was 1 h and 45 min,respectively.The adult recipient in the first case had portal vein thrombosis,and received portal-cava bridge.All of the 4 recipients recovered well during the early post-operative stage.Conclusion In situ splitting transplantation in type 1 Chinese DCD is safe and feasible,and it has potential to expand the donor pool.Delicate pre-operative evaluation is important to ensure the application of this procedure.