摘要
目的总结儿童亲体肝移植的临床疗效与经验。方法回顾性分析2021年9月至2023年2月新疆医科大学第一附属医院实施的11例亲体肝移植患儿临床资料,原发病包括:胆道闭锁2例,门静脉海绵样变性2例,肝豆状核变性3例,酪氨酸血症Ⅰ型1例,先天性肝纤维化2例,布-加综合征1例。肝移植术后均予抗感染、保肝、利胆、抗凝及免疫抑制治疗;8例采取他克莫司+吗替麦考酚酯加甲基强的松龙三联免疫抑制治疗,3例采取他克莫司加甲基强的松龙二联免疫抑制治疗。结果11例手术时间(11.85±1.85)h,移植物与受体重量比(graft-to-recipient weight ratio,GRWR)为(2.20±2.03)%,冷缺血时间为(75.91±20.87)min,热缺血时间为(2.63±2.30)min,无肝期时间为(60.55±18.86)min,术中出血量为(770.91±541.12)mL。11例中行胆道端端吻合术4例,胆肠吻合术7例。术后无一例血管及胆道相关并发症,但出现血小板减少1例、肺部感染1例、淋巴漏2例、癫痫发作1例、高血压伴烦躁不安1例,均经对症治疗后痊愈出院。供体无一例术后并发症。结论亲体肝移植术是治疗儿童终末期肝病及部分肝脏遗传代谢性疾病的有效手段,应严格把握不同原发疾病的肝移植手术指征,并结合个体化围手术期管理,以提高手术成功率,减少并发症。
Objective To summarize the clinical efficacies and outcomes of pediatric living donor liver transplantation(LDLT).Methods From September 2021 to February 2023,retrospective analysis was performed for the relevant clinical data of 11 children undergoing LDLT at First Affiliated Hospital of Xinjiang Medical University.Primary diseases included biliary atresia(n=2),portal vein cavernous degeneration(n=2),hepatolenticular degeneration(n=3),tyrosinemia typeⅠ(n=1),congenital liver fibrosis(n=2)and Budd-Chiari syndrome(n=1).Postoperative interventions included anti-infection,liver protection,bile promotion,anticoagulation and immunosuppression.The immunosuppressive protocols were a triple regimen of tacrolimus,mycophenolate mofetil and methylprednisolone(n=8)and a dual regimen of tacrolimus and methylprednisolone(n=3).Results Mean operative duration was(11.85±1.85)h,mean graft-to-recipient weight ratio(GRWR)(2.20±2.03)%,mean cold ischemic time(75.91±20.87)min,mean warm ischemic time(2.63±2.30)min,mean anhepatic period(60.55±18.86)min and mean intraoperative volume of hemorrhagic loss(770.91±541.12)mL.End-to-end biliary anastomosis(n=4)and bile-intestinal anastomosis(n=7)were performed.There were no vascular or biliary postoperative complications.However,there were thrombocytopenia(n=1),lung infection(n=1),lymphatic leakage(n=2),seizure(n=1)and hypertension with irritability(n=1).All of them were cured and discharged after symptomatic measures.No postoperative complications occurred in donors.Conclusions LDLT is an effective treatment for end-stage liver disease and some genetically metabolic liver diseases in children.Indications for LDLT should be strictly tailored for different primary diseases.And perioperative managements are individualized for optimizing long-term survivals and quality-of-life.
作者
刘辉
古力米热木·买买提江
李万富
沈中阳
高伟
董冲
孙超
阿尔新·哈布丁
樊珈榕
Liu Hui;Gulimiremu Maimaitijiang;Li Wanfu;Shen Zhongyang;Gao Wei;Dong Chong;Sun Chao;Aerxin Habuding;Fan Jiarong(Department of General Pediatric Surgery,First Affiliated Hospital,Xinjiang Medical University,Urumqi 830054,China;Department of Pediatric Organ Transplantation,First Central Municipal Hospital,Tianjin 300192,China)
出处
《临床小儿外科杂志》
CAS
CSCD
2023年第12期1124-1129,共6页
Journal of Clinical Pediatric Surgery
基金
国家自然科学基金面上项目(82170672)
关键词
肝移植/方法
活体供者/分类
活体肝移植
免疫抑制法
治疗结果
儿童
Liver Transplantation/MT
Living Donors/CL
Living Donor Liver Transplantation
Immunosuppression
Treatment Outcome
Child
