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目的总结以左肝外侧叶(Ⅱ、Ⅲ段)为供肝的小儿肝移植的手术经验。方法对11例患有肝脏疾病的儿童施行左肝外侧叶移植,其中劈离式肝移植10例,亲属活体供肝部分肝移植1例,有8例患儿既往有腹部手术史。结果术后11例患者均存活。本组切取的左肝外侧叶的重量平均为276.2g,移植肝重量与受者体重之比平均为2.34%,供、受者的体重之比平均为5.42;供肝冷缺血时间平均为11.3h。受者的手术耗时平均为4.2h,无肝期平均为69min;6例患儿在肝移植完成之初采取了临时性关腹。1例患儿术后第15d发生胃幽门部穿孔,2例患儿因腹腔容积的限制在术后24h内发生肝动脉受压。本组病例未发生肝静脉流出道梗阻、肝动脉栓塞、移植肝无功能或坏死、供肝断面胆瘘等并发症。结论小儿接受左肝外侧叶移植的效果良好;术中宜同时开放肝动脉和门静脉;临时性关腹优点显著,值得运用。
Objective To summarize the surgical experience of pediatric liver transplantation in the left hepatic lateral lobe (Ⅱ, Ⅲ). Methods Eleven children with liver disease underwent lateral lobe graft of left liver, including 10 cases of split liver transplantation and 1 case of partial liver transplantation by relatives. There were 8 cases of previous abdominal surgery. Results All the 11 patients survived. The average weight of lateral lobes of the left liver extracted from this group was 276.2g, the average ratio of graft weight to recipient weight was 2.34%, the average weight ratio of donor and recipient was 5.42, and the average time for cold ischemia was 11.3 h Recipients of the operation time-consuming average of 4.2h, anhepatic period average of 69min; 6 children at the beginning of liver transplantation to take a temporary closure of the abdomen. One patient had gastric pyloric perforation 15 days after operation, and two patients had hepatic artery compression within 24h after operation due to the restriction of abdominal volume. This group of patients without hepatic vein outflow tract obstruction, hepatic artery embolization, graft dysfunction or necrosis, liver section biliary fistula and other complications. Conclusion Pediatric left lateral lobe transplantation has a good effect. It is advisable to open both the hepatic artery and portal vein at the same time. The advantage of temporary closure is significant and worthy of application.