摘要目的 探讨精准肝脏外科技术在活体肝移植供肝切取中的应用价值.方法 收集2006年6月至2013年12月在解放军总医院肝胆外科医院行活体肝移植的89名供者的临床资料,年龄19 ～57岁.术前联合影像学检查和肝脏储备功能检查进行肝脏功能评估、肝脏体积评估和血管、胆管评估,制订个体化手术方案.根据术后结果分析术前评估的准确性及术后肝功能、并发症发生情况.术前根据二维和三维方法计算的预切除肝体积与术后切取肝实际质量之间的比较采用方差分析,相关性分析采用Pearson检验,并进行线性回归分析.结果 89名供者中,切取左外叶5名、左半肝10名、右半肝74名,59名切取肝中静脉、30名不切取肝中静脉.术前依靠二维和三维方法计算肝脏体积的平均误差率分别为7.9％和5.3％,术前CT计算肝脏体积与术后切除标本体积差异无统计学意义(P＞0.05),两种评估方法与实测肝质量呈正相关(r值分别为0.821、0.890,P＜0.01).回归分析结果提示,两种评估方法与术后切除标本质量之间R2值分别为0.674和0.792.术前门静脉、肝静脉、肝动脉、胆管评估准确率分别为100％、100％、97.8％、95.5％.术前手术方案与术后实际方案符合率为95.5％.供者并发症发生率为7.4％.所有供者均恢复良好出院.16名保留胆囊的右半肝切除供者肝功能良好,胆囊功能良好.结论 精准肝脏外科技术运用于活体肝移植,通过精确的术前评估、精密的手术规划、精细的手术操作、精良的术后管理,能有效地保障供者安全.

abstractsObjective To evaluate the effect of techniques of precise liver surgery for donor hepatectomy in living donor liver transplantation.Methods Eighty-nine donors aged from 19 to 57 years were performed by the same surgical team from June 2006 to December 2013 in Chinese People's Liberation Army General Hospital.Individualized surgical program were developed according to preoperative imaging examination and hepatic functional reserve examination.The evaluation included liver function,liver volume,vascular anatomy and bile duct anatomy.According to the results after the operation,preoperative evaluation accuracy,postoperative donor liver function and postoperative complications were analyzed.ANOVA analysis was used to compare the difference of graft volume by two-dimensional,three-dimensional calculation method and actual postoperative graft weight.Pearson correlation test and linear regression analysis were used to verify the correlation between the estimated graft volume each method and actual graft postoperative weight.Results All the 89 cases operation protocol as following,there were 5 cases with left lateral lobe graft,10 cases with left lobe liver graft,74 cases with right lobe graft.There were 59 cases with middle hepatic vein (MHV) harvested,and 30 cases without MHV.The mean graft volume by two-dimensional,three-dimensional calculation method and actual postoperative graft weight were (656.2 ± 134.1) ml,(631.7 ± 143.2) ml and (614.5 ± 137.7)ml respectively.ANOVA analysis results showed that there were no statistically significant difference in the three methods (P ＞ 0.05).Compared to the actual postoperative graft weight,the average error rate of the two methods were 7.9％ and 5.3％ respectively.Pearson correlation test showed the graft volume calculated by two-dimensional and three-dimensional methods had a significantly positive correlation with actual graft weight (r =0.821,0.890,P ＜ 0.01) and linear regression analyze showed the R2 were 0.674 and 0.792,respectively.The accuracy rate of preoperative evaluation about portal vein,hepatic vein,hepatic artery and bile duct were 100％,100％,97.8％ and 95.5％,respectively.The preoperative plan and postoperative practical scheme coincidence rate was 95.5％.Overall donor complication rate was 7.4％.All donors were alive.Sixteen donors received right lobe hepatectomy with gallbladder preserved had a good liver function and gallbladder function.Conclusion Through the precise preoperative evaluation,surgical planning,fine operation and excellent postoperative management,precise liver surgery technique can ensure the safety of donor in living donor liver transplantation.