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劈离式肝移植围手术期管理

李川, 赖彦华. 劈离式肝移植围手术期管理[J]. 器官移植, 2022, 13(5): 577-582. doi: 10.3969/j.issn.1674-7445.2022.05.005
引用本文: 李川, 赖彦华. 劈离式肝移植围手术期管理[J]. 器官移植, 2022, 13(5): 577-582. doi: 10.3969/j.issn.1674-7445.2022.05.005
Li Chuan, Lai Yanhua. Perioperative management of split liver transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(5): 577-582. doi: 10.3969/j.issn.1674-7445.2022.05.005
Citation: Li Chuan, Lai Yanhua. Perioperative management of split liver transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(5): 577-582. doi: 10.3969/j.issn.1674-7445.2022.05.005

劈离式肝移植围手术期管理

doi: 10.3969/j.issn.1674-7445.2022.05.005
基金项目: 

广西医疗卫生适宜技术开发与推广应用项目 S2018086

详细信息
    作者简介:
    通讯作者:

    赖彦华,Email:1379771812@qq.com

  • 中图分类号: R617, R575

Perioperative management of split liver transplantation

More Information
  • 摘要: 在肝源短缺的背景下,劈离式肝移植实现了“一肝两用”的目的,有效缓解了供肝短缺的现状,具有较大的发展前景。且随着肝移植手术技术的进步,劈离式肝移植可获得接近全肝移植的预后。但劈离式肝移植围手术期管理仍面临着诸多挑战,其技术要求更高,发生并发症的风险较大,并有可能将1个高质量的供肝转化为2个边缘供肝,影响肝移植手术的开展。本文就术前评估、受者管理及术后并发症管理等方面探讨劈离式肝移植的围手术期管理,为促进临床劈离式肝移植的发展,改善劈离式肝移植受者预后提供参考。

     

  • 图  1  门静脉变异示意图及影像学检查结果

    注:A图为门静脉解剖变异示意图;B图为门静脉变异供者CT图像;C图为门静脉变异供者超声图像。a为门静脉右前支;b为门静脉右后支;c为门静脉左支。

    Figure  1.  Schematic diagram and imaging examination results of portal vein variation

    图  2  劈离式肝移植术后胆汁湖形成的CT图像

    Figure  2.  CT image of bile lake after split liver transplantation

    图  3  T管留置的胆道造影图

    Figure  3.  Cholangiography image with indwelling T tube

  • [1] 中华医学会外科学分会外科手术学学组, 中华医学会外科学分会移植学组. 劈离式肝移植专家共识[J/CD]. 中华肝脏外科手术学电子杂志, 2020, 9(5): 429-434. DOI: 10.3877/cma.j.issn.2095-3232.2020.05.008.

    Operative Surgical Group of Branch of Surgery of Chinese Medical Association. Transplantation Group of Branch of Surgery of Chinese Medical Association. Expert consensus on split liver transplantation[J/CD]. Chin J Hepatic Surg (Electr Edit), 2020, 9(5): 429-434. DOI: 10.3877/cma.j.issn.2095-3232.2020.05.008.
    [2] 赖彦华, 何俊鑫, 庞飞雄, 等. 原位劈离式肝移植单中心经验[J]. 中国临床新医学, 2020, 13(12): 1204-1207. DOI: 10.3969/j.issn.1674-3806.2020.12.05.

    LAI YH, HE JX, PANG FX, et al. In situ split liver transplantation: a single-center experience[J]. Chin J New Clin Med, 2020, 13(12): 1204-1207. DOI: 10.3969/j.issn.1674-3806.2020.12.05.
    [3] GAO W, SONG Z, MA N, et al. Application of pediatric donors in split liver transplantation: is there an age limit?[J]. Am J Transplant, 2020, 20(3): 817-824. DOI: 10.1111/ajt.15641.
    [4] LIN YH, CAI ZS, JIANG Y, et al. Perioperative risk factors for pulmonary complications after liver transplantation[J]. J Int Med Res, 2010, 38(5): 1845-1855. DOI: 10.1177/147323001003800532.
    [5] LEE SA, HYUN J, YOON YI, et al. Clinical impact of mild to moderate pulmonary hypertension in living-donor liver transplantation[J]. Transpl Int, 2021, 34(6): 1150-1160. DOI: 10.1111/tri.13875.
    [6] ACHO C, MORITA Y, FERNANDEZ V, et al. Immediate postoperative extubation decreases pulmonary complications in liver transplant patients[J]. Transplantation, 2021, 105(9): 2018-2028. DOI: 10.1097/TP.0000000000003450.
    [7] KROWKA MJ, FALLON MB, KAWUT SM, et al. International Liver Transplant Society practice guidelines: diagnosis and management of hepatopulmonary syndrome and portopulmonary hypertension[J]. Transplantation, 2016, 100(7): 1440-1452. DOI: 10.1097/TP.0000000000001229.
    [8] 中国医师协会器官移植医师分会移植免疫学专业委员会, 中国研究型医院学会加速康复外科委员会肝移植加速康复学组. 成人慢加急性肝衰竭肝移植围手术期管理专家共识[J]. 器官移植, 2020, 11(5): 533-542. DOI: 10.3969/j.issn.1674-7445.2020.05.001.

    Transplantation Immunology Committee of Branch of Organ Transplantation Physician of Chinese Medical Doctor Association, Enhanced Recovery of Liver Transplantation Group of Enhanced Recovery after Surgery Committee of Chinese Research Hospital Society. Expert consensus on perioperative management of liver transplantation in adults with acute-on-chronic liver failure[J]. Organ Transplant, 2020, 11(5): 533-542. DOI: 10.3969/j.issn.1674-7445.2020.05.001.
    [9] BISCHOFF SC, BERNAL W, DASARATHY S, et al. ESPEN practical guideline: clinical nutrition in liver disease[J]. Nutr Hosp, 2022, 39(2): 434-472. DOI: 10.20960/nh.03856.
    [10] SILVA DMD, HENZ AC, FERNANDES SA, et al. Nutritional diagnosis of patients with hepatocellular carcinoma: what is the best method?[J]. Nutr Hosp, 2019, 36(4): 884-889. DOI: 10.20960/nh.02542.
    [11] POULIA KA, KLEK S, DOUNDOULAKIS I, et al. The two most popular malnutrition screening tools in the light of the new ESPEN consensus definition of the diagnostic criteria for malnutrition[J]. Clin Nutr, 2017, 36(4): 1130-1135. DOI: 10.1016/j.clnu.2016.07.014.
    [12] SINGER P, BERGER MM, VAN DEN BERGHE G, et al. ESPEN guidelines on parenteral nutrition: intensive care[J]. Clin Nutr, 2009, 28(4): 387-400. DOI: 10.1016/j.clnu.2009.04.024.
    [13] 胡丽超, 李佳丽, 杨占甲. 血栓弹力图在肝移植围术期凝血功能评价中的应用[J]. 临床研究, 2020, 28(5): 29-30. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYN202005013.htm

    HU LC, LI JL, YANG ZJ. Application of thromboelastograms in the evaluation of perioperative coagulation function in liver transplantation[J]. Clin Res, 2020, 28(5): 29-30. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYN202005013.htm
    [14] 中华医学会器官移植学分会围手术期管理学组. 成人肝移植受者围术期凝血功能管理专家共识(2021版)[J/CD]. 实用器官移植电子杂志, 2021, 9(2): 89-94. DOI:10.3969/j.issn.2095-5332.2021.02.001.

    Perioperative Management Group of Branch of Organ Transplantation of Chinese Medical Association. Expert consensus on perioperative coagulation function management in adult liver transplantation recipients (2021 edition)[J/CD]. Pract J Organ Transplant (Electr Vers), 2021, 9(2): 89-94. DOI: 10.3969/j.issn.2095-5332.2021.02.001.
    [15] LIN M, MITTAL S, SAHEBJAM F, et al. Everolimus with early withdrawal or reduced-dose calcineurin inhibitors improves renal function in liver transplant recipients: a systematic review and Meta-analysis[J]. Clin Transplant, 2017, 31(2): e12872. DOI: 10.1111/ctr.12872.
    [16] WANG T, YAN M, TANG D, et al. Therapeutic drug monitoring and safety of voriconazole therapy in patients with Child-Pugh class B and C cirrhosis: a multicenter study[J]. Int J Infect Dis, 2018, 72: 49-54. DOI: 10.1016/j.ijid.2018.05.009.
    [17] ASLAM S, ROTSTEIN C, AST Infectious Disease Community of Practice. Candida infections in solid organ transplantation: guidelines from the American Society of Transplantation Infectious Diseases Community of Practice[J]. Clin Transplant, 2019, 33(9): e13623. DOI: 10.1111/ctr.13623.
    [18] HUSAIN S, CAMARGO JF. Invasive aspergillosis in solid-organ transplant recipients: guidelines from the American Society of Transplantation Infectious Diseases Community of Practice[J]. Clin Transplant, 2019, 33(9): e13544. DOI: 10.1111/ctr.13544.
    [19] CHAKRAVARTI A, BUTLER-LAPORTE G, CARRIER FM, et al. Targeted caspofungin prophylaxis for invasive aspergillosis in high-risk liver transplant recipients, a single-center experience[J]. Transpl Infect Dis, 2021, 23(4): e13568. DOI: 10.1111/tid.13568.
    [20] KANG WH, SONG GW, LEE SG, et al. A multicenter, randomized, open-label study to compare micafungin with fluconazole in the prophylaxis of invasive fungal infections in living-donor liver transplant recipients[J]. J Gastrointest Surg, 2020, 24(4): 832-840. DOI: 10.1007/s11605-019-04241-w.
    [21] 孙延东, 徐庆国, 李天翔, 等. 肝中静脉完全劈分-重建技术在双成人劈离式肝移植中的应用[J]. 中华外科杂志, 2021, 59(6): 535-538. DOI: 10.3760/cma.j.cn112139-20200913-00700.

    SUN YD, XU QG, LI TX, et al. Application of complete hepatic vein splitting and reconstruction technique in dual adult split liver transplantation[J]. Chin J Surg, 2021, 59(6): 535-538. DOI: 10.3760/cma.j.cn112139-20200913-00700.
    [22] BALCI D, KIRIMKER EO. Hepatic vein in living donor liver transplantation[J]. Hepatobiliary Pancreat Dis Int, 2020, 19(4): 318-323. DOI: 10.1016/j.hbpd.2020.07.002.
    [23] MOURAD MM, LIOSSIS C, GUNSON BK, et al. Etiology and management of hepatic artery thrombosis after adult liver transplantation[J]. Liver Transpl, 2014, 20(6): 713-723. DOI: 10.1002/lt.23874.
    [24] MAGAND N, CORONADO JL, DREVON H, et al. Primary angioplasty or stenting for hepatic artery stenosis treatment after liver transplantation[J]. Clin Transplant, 2019, 33(12): e13729. DOI: 10.1111/ctr.13729.
    [25] 冉江华, 张升宁, 李铸, 等. 肝动脉-腹主动脉搭桥在原位肝移植术中的应用[J]. 中国普外基础与临床杂志, 2008, 15(2): 102-105. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWL200802013.htm

    RAN JH, ZHANG SN, LI Z, et al. Application of hepatic artery reconstruction with iliac arterial interposition graft in orthotopic liver transplantation[J]. Chin J Bases Clin Gen Surg, 2008, 15(2): 102-105. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWL200802013.htm
    [26] BARLOTTA KS, PAGE D. Hepatic artery rupture in a young man with abdominal pain and a testicular mass[J]. J Emerg Med, 2017, 52(2): e33-e36. DOI: 10.1016/j.jemermed.2016.07.109.
    [27] BHANGUI P, FERNANDES ESM, DI BENEDETTO F, et al. Current management of portal vein thrombosis in liver transplantation[J]. Int J Surg, 2020, 82(Suppl): 122-127. DOI: 10.1016/j.ijsu.2020.04.068.
    [28] YERDEL MA, GUNSON B, MIRZA D, et al. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome[J]. Transplantation, 2000, 69(9): 1873-1881. DOI: 10.1097/00007890-200005150-00023.
    [29] 罗方舟, 杨喆, 郑树森. 门静脉血栓与肝移植[J/CD]. 中华移植杂志(电子版), 2019, 13(3): 245-251. DOI: 10.3877/cma.j.issn.1674-3903.2019.03.019.

    LUO FZ, YANG Z, ZHENG SS. Portal vein thrombosis and liver transplantation[J/CD]. Chin J Transplant (Electr Edit), 2019, 13(3): 245-251. DOI: 10.3877/cma.j.issn.1674-3903.2019.03.019.
    [30] ZHAO JZ, QIAO LL, DU ZQ, et al. T-tube vs no T-tube for biliary tract reconstruction in adult orthotopic liver transplantation: an updated systematic review and Meta-analysis[J]. World J Gastroenterol, 2021, 27(14): 1507-1523. DOI: 10.3748/wjg.v27.i14.1507.
    [31] XU YB, MIN ZG, JIANG HX, et al. Diagnostic value of magnetic resonance cholangiopancreatography for biliary complications in orthotopic liver transplantation: a Meta-analysis[J]. Transplant Proc, 2013, 45(6): 2341-2346. DOI: 10.1016/j.transproceed.2013.03.031.
    [32] DAHM F, GEORGIEV P, CLAVIEN PA. Small-for-size syndrome after partial liver transplantation: definition, mechanisms of disease and clinical implications[J]. Am J Transplant, 2005, 5(11): 2605-2610. DOI: 10.1111/j.1600-6143.2005.01081.x.
    [33] 中华医学会器官移植学分会, 中国医师协会器官移植医师分会. 中国活体肝移植小肝综合征临床诊治指南(2016版)[J]. 临床肝胆病杂志, 2017, 33(10): 1870-1875. DOI: 10.3969/j.issn.1001-5256.2017.10.005.

    Branch of Organ Transplantation of Chinese Medical Association. Chinese guidelines for clinical diagnosis and treatment of small-for-size syndrome after living donor liver transplantation (2016 edition)[J]. J Clin Hepatol, 2017, 33(10): 1870-1875. DOI: 10.3969/j.issn.1001-5256.2017.10.005.
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出版历程
  • 收稿日期:  2022-06-01
  • 网络出版日期:  2022-09-14
  • 刊出日期:  2022-09-15

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