儿童小体积供肝肝移植治疗成人急性肝衰竭1例附文献复习

叶征辉; 赵红川; 黄帆; 王国斌; 余孝俊; 侯刘进

doi:10.3969/j.issn.1674-7445.2018.03.011

儿童小体积供肝肝移植治疗成人急性肝衰竭1例附文献复习

doi: 10.3969/j.issn.1674-7445.2018.03.011

230022 合肥，安徽医科大学第一附属医院普外科暨器官移植中心

基金项目:

安徽省青年科学基金项目 81401617

详细信息

作者简介:
叶征辉，男，1991年，硕士研究生，研究方向为肝胆胰外科，Email：767725431@qq.com

通讯作者:
赵红川，男，1969年，博士，主任医师，研究方向为器官移植，Email：zhc0117@sina.com

中图分类号: R617
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出版历程
- 收稿日期: 2018-01-20
- 网络出版日期: 2021-01-19
- 刊出日期: 2018-05-15

Application of small-for-size graft of pediatric donor liver transplantation in an adult recipient with acute liver failure: a report of one case and literature review

Department of General Surgery, Organ Transplantation Center, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China

More Information

Corresponding author: Zhao Hongchuan, Email: zhc0117@sina.com

摘要

摘要: 目的总结儿童小体积供肝肝移植治疗成人急性肝衰竭的临床经验。方法回顾性分析1例低龄儿童小体积供肝肝移植治疗成人急性肝衰竭病例的临床资料并进行文献复习。结果供体为4.5岁儿童，脑死亡器官捐献供肝质量为544.6 g，受体体质量52 kg，移植物受体体质量比为1.05%。手术采用经典原位肝移植术。术后艰难康复，相继并发脑水肿、应激性消化道大出血、急性肾损伤、小肝综合征、肺不张、肺部感染、真菌感染、腹腔感染、胸腔积液等并发症。经对症综合治疗后，移植肝功能逐渐恢复正常，2~3周再生至移植成人标准肝体积大小，住院102 d后康复出院。术后10个月随访受体肝功能正常，生活质量良好。结论儿童小体积供肝可以成功应用于成人受体，但需要根据供肝情况选择合适的受体、手术方式及围手术期精细管理。
- 肝移植 /
- 小体积 /
- 儿童供肝 /
- 急性肝衰竭 /
- 移植物受体体质量比 /
- 小肝综合征 /
- 胸腔积液 /
- 肝再生 /
- 肺部感染 /
- 真菌感染 /
- 腹腔感染
Abstract: Objective To summarize the clinical experience of small-for-size graft of pediatric donor liver transplantation in the treatment of acute liver failure in an adult recipient. Methods Clinical data of application of small-for-size graft of pediatric donor liver transplantation in an adult recipient was retrospectively analyzed and literature review was performed. Results The pediatric donor was aged 4.5 years old and the weight of donor liver from donation after brain death was 544.6 g. The body mass of recipient was 52 kg. The graft-to-recipient weight ratio was 1.05%. The classic orthotopic liver transplantation was performed. Postoperative recovery was not satisfying. The recipient suffered from brain edema, stress gastrointestinal bleeding, acute kidney injury, small-for-size liver syndrome, atelectasis, lung infection, fungal infection, abdominal infection, pleural effusion and other postoperative complications. After symptomatic and comprehensive treatment, the function of liver graft was gradually restored and regenerated to the normal size of adult liver at postoperative 2 to 3 weeks. The patient was discharged after 102 d hospitalization. During the follow-up at postoperative 10 months, the liver function was evaluated normal and the quality of life was favorable. Conclusions Pediatric small-for-size donor livers can be successfully transplanted to the adult recipients. Nevertheless, it is necessary to select the appropriate recipients, surgical methods and fine perioperative management according to the conditions of the donor livers.
- Liver transplantation /
- Small-for-size /
- Pediatric donor liver /
- Acute liver failure /
- Graft-to-recipient weight ratio /
- Small-for-size liver syndrome /
- Pleural effusion /
- Liver regeneration /
- Pulmonary infection /
- Fungal infection /
- Abdominal infection

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图 1 1例儿童小体积供肝肝移植手术、影像学及病理学图片

A图示供肝外观；B图示供肝质量544.6 g；C图为移植肝恢复血流后的外观；D图示留置1根8号T管经受体段胆总管前壁引出；E图为术后3个月后复查T管造影示肝内外胆管显影；F图为术后2周复查CT示移植肝增大至成人标准肝体积大小；G图为切除病肝的外观；H图为病肝病理学检查示肝小叶结构破坏，肝细胞大片坏死

Figure 1. Operation, imaging and pathology pictures of 1 case with small-for-size graft in padiatric donor liver transplantation

下载: 全尺寸图片幻灯片

参考文献(14)

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