带有血管瘤的肝切除标本在肝移植中的应用
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摘要
目的探讨利用带有血管瘤的肝切除标本作为供肝肝移植的安全性与疗效。方法回顾性分析2012年11月至2015年10月在南京医科大学第一附属医院利用带有血管瘤的左半肝切除标本作为供肝行肝移植的2例供者和2例受者临床资料。供者均为成人,其中男1例,年龄41岁;女1例,年龄50岁,均诊断为左半肝海绵状血管瘤。受者中,男1例,年龄27岁,诊断为肝细胞癌、乙型病毒性肝炎肝硬化;另1例为小儿,男,年龄7个月,诊断为胆汁淤积性肝硬化、先天性胆道闭锁。供受者和(或)家属均签署知情同意书,符合医学伦理学规定。2例供肝均为左半肝,其中1例未切除血管瘤,1例切除血管瘤,均行改良背驮式肝移植术。观察患者术后恢复及移植肝增生情况。结果 2例肝移植术均顺利完成。2例供者术后恢复良好,残余肝脏增长较快,康复出院。2例受者术后恢复顺利,未发生原发性移植肝无功能、小肝综合征和排斥反应等并发症。1例受者术后11 d、3个月、6个月CT检查提示移植肝体积迅速增大,血管瘤体积无明显变化,且术后13、23、29个月CT检查示血管瘤明显缩小,肝体积无明显增大。结论利用带有血管瘤的肝切除标本作为供肝进行肝移植手术是安全的,可在一定程度上缓解供肝短缺的情况。
Objective To investigate the safety and clinical efficacy of liver resection specimens with hemangioma as donor liver in liver transplantation(LT).Methods Clinical data of 2 donors and 2 recipients who underwent LT using the left liver resection specimens with hemangioma as donor liver in the Frist Affiliated Hospital of Nanjing Medical University between November 2012 and October 2015 were retrospectively analyzed.Among the donors,1 case was a 41-year-old male and the other was a 50-year-old female.They were both adult and diagnosed with cavernous hemangioma in the left lobe.Among the recipients,1 case was a27-year-old male and diagnosed with hepatocellular carcinoma and liver cirrhosis after hepatitis B,and the other case was a 7-month-old boy and diagnosed with biliary liver cirrhosis and congenital biliary atresia.The informed consents of all donors and recipients or their relatives were obtained and the local ethical committee approval was received.The donor livers including 1 case without hemangioma resection and the other case with hemangioma resection,were both obtained from the left lobe and used for the modified piggyback LT.The postoperative recovery of the patients and the proliferation of the transplanted liver were observed.Results LT was successfully performed.Two donors recovered well after surgery with fast residual liver proliferation and were both discharged.Two recipients recovered well after surgery and no complications including primary liver graft non-function,small-for-size syndrome or rejection response were observed.CT scan of 1 recipient at 11 d,3 and 6 months after surgery indicated that the transplanted liver volume enlarged rapidly while no significant change was observed in the hemangioma volume.And CT scan of the recipient at 13,23 and 29 months after surgery indicated that significant reduction was observed in the hemangioma volume while no obvious enlargement was observed in the liver volume.Conclusions It is safe to use the liver resection specimens with hemangioma as donor liver for LT.It can relieve the shortage of donor liver to a certain degree.
Objective To investigate the safety and clinical efficacy of liver resection specimens with hemangioma as donor liver in liver transplantation(LT).Methods Clinical data of 2 donors and 2 recipients who underwent LT using the left liver resection specimens with hemangioma as donor liver in the Frist Affiliated Hospital of Nanjing Medical University between November 2012 and October 2015 were retrospectively analyzed.Among the donors,1 case was a 41-year-old male and the other was a 50-year-old female.They were both adult and diagnosed with cavernous hemangioma in the left lobe.Among the recipients,1 case was a27-year-old male and diagnosed with hepatocellular carcinoma and liver cirrhosis after hepatitis B,and the other case was a 7-month-old boy and diagnosed with biliary liver cirrhosis and congenital biliary atresia.The informed consents of all donors and recipients or their relatives were obtained and the local ethical committee approval was received.The donor livers including 1 case without hemangioma resection and the other case with hemangioma resection,were both obtained from the left lobe and used for the modified piggyback LT.The postoperative recovery of the patients and the proliferation of the transplanted liver were observed.Results LT was successfully performed.Two donors recovered well after surgery with fast residual liver proliferation and were both discharged.Two recipients recovered well after surgery and no complications including primary liver graft non-function,small-for-size syndrome or rejection response were observed.CT scan of 1 recipient at 11 d,3 and 6 months after surgery indicated that the transplanted liver volume enlarged rapidly while no significant change was observed in the hemangioma volume.And CT scan of the recipient at 13,23 and 29 months after surgery indicated that significant reduction was observed in the hemangioma volume while no obvious enlargement was observed in the liver volume.Conclusions It is safe to use the liver resection specimens with hemangioma as donor liver for LT.It can relieve the shortage of donor liver to a certain degree.
引文
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[13]王连江,张雅敏,邓永林,等.肝移植治疗肝脏良性肿瘤六例临床分析[J].中华医学杂志,2016,96(26):2091-2093.
[14]Mor E,Boccagni P,Thung SN,et al.Backtable resection of a giant cavernous hemangioma in a donor liver[J].Transplantation,1995,60(6):616-617.
[15]Onaca N,Mizrahi S,Bar Nathan N,et al.Liver transplantation after backtable resection of giant hemangioma[J].Liver Transpl,2005,11(7):851-852.
[16]Pacheco-Moreira LF,Enne M,Balbi E,et al.Hemangioma at the liver section plane.is it a contraindication for living donor liver transplantation?[J].Surgery,2005,138(1):113.
[17]Aucejo FN,Ortiz WA,Kelly D,et al.Expanding the donor pool:safe transplantation of a cadaveric liver allograft with a 10 cm cavernous hemangioma--a case report[J].Liver Transpl,2006,12(4):687-689.
[18]Nikeghbalian S,Kazemi K,Salahi H,et al.Transplantation of a cadaveric liver allograft with right lobe cavernous hemangioma,without back-table resection:a case report[J].Transplant Proc,2007,39(5):1691-1692.
[19]Sanada Y,Mizuta K,Urahashi T,et al.Pediatric living donor liver transplantation using liver allograft with hemangioma[J].Ann Transplant,2011,16(1):66-69.
[20]Onishi Y,Kamei H,Imai H,et al.Successful adult-to-adult living donor liver transplantation using liver allograft after the resection of hemangioma:a suggestive case for a further expansion of living donor pool[J].Int J Surg Case Rep,2015(16):166-170.
[2]Sun B,Mu X,Wang X.Successful adult-to-adult liver transplantation of an otherwise discarded partial liver allograft with a cavernous hemangioma:new strategy for expanding liver donor pool[J].Transpl Int,2013,26(9):e79-80.
[3]孙倍成,钱晓峰,夏永祥,等.采用带血管瘤的肝切除标本为供肝的肝移植术后近期随访报告[J].中华外科杂志,2014,52(2):81-84.
[4]钱晓峰,母小新,孙倍成.带血管瘤的肝切除标本作为供肝肝移植一例[J].江苏医药,2014,40(24):3082-3084.
[5]王学浩,李国强.我国肝移植现状与面临的挑战[J].中华消化外科杂志,2013,12(9):641-643.
[6]Pezzati D,Ghinolfi D,De Simone P,et al.Strategies to optimize the use of marginal donors in liver transplantation[J].World J Hepatol,2015,7(26):2636-2647.
[7]关正,吕毅.提高肝移植边缘供肝质量的研究进展[J].医学综述,2015,21(4):671-674.
[8]Goldaracena N,Qui?onez E,Méndez P,et al.Extremely marginal liver grafts from deceased donors have outcome similar to ideal grafts[J].Transplant Proc,2012,44(7):2219-2222.
[9]吴新民,秦长春,刘林勋.手术切除治疗肝血管瘤患者的临床研究[J/CD].中华肝脏外科手术学电子杂志,2013,2(3):149-152.
[10]Zhong L,Men TY,Yang GD,et al.Case report:living donor liver transplantation for giant hepatic hemangioma using a right lobe graft without middle hepatic vein[J].World J Surg Oncol,2014(12):83.
[11]Lange UG,Bucher JN,Schoenberg MB,et al.Orthotopic liver transplantation for giant liver haemangioma:a case report[J].World JTransplant,2015,5(4):354-359.
[12]陈规划,陆敏强,朱晓峰,等.原位肝移植治疗肝脏巨大海绵状血管瘤[J].中华器官移植杂志,1999,20(2):71-72.
[13]王连江,张雅敏,邓永林,等.肝移植治疗肝脏良性肿瘤六例临床分析[J].中华医学杂志,2016,96(26):2091-2093.
[14]Mor E,Boccagni P,Thung SN,et al.Backtable resection of a giant cavernous hemangioma in a donor liver[J].Transplantation,1995,60(6):616-617.
[15]Onaca N,Mizrahi S,Bar Nathan N,et al.Liver transplantation after backtable resection of giant hemangioma[J].Liver Transpl,2005,11(7):851-852.
[16]Pacheco-Moreira LF,Enne M,Balbi E,et al.Hemangioma at the liver section plane.is it a contraindication for living donor liver transplantation?[J].Surgery,2005,138(1):113.
[17]Aucejo FN,Ortiz WA,Kelly D,et al.Expanding the donor pool:safe transplantation of a cadaveric liver allograft with a 10 cm cavernous hemangioma--a case report[J].Liver Transpl,2006,12(4):687-689.
[18]Nikeghbalian S,Kazemi K,Salahi H,et al.Transplantation of a cadaveric liver allograft with right lobe cavernous hemangioma,without back-table resection:a case report[J].Transplant Proc,2007,39(5):1691-1692.
[19]Sanada Y,Mizuta K,Urahashi T,et al.Pediatric living donor liver transplantation using liver allograft with hemangioma[J].Ann Transplant,2011,16(1):66-69.
[20]Onishi Y,Kamei H,Imai H,et al.Successful adult-to-adult living donor liver transplantation using liver allograft after the resection of hemangioma:a suggestive case for a further expansion of living donor pool[J].Int J Surg Case Rep,2015(16):166-170.