• 四川大學(xué)華西醫(yī)院普外科（成都610041）;

目的 探討成人活體部分肝移植中供肝移植物大小與術(shù)式的臨床抉擇。方法采用文獻(xiàn)回顧的方法對(duì)活體部分肝移植中供體的評(píng)估、供肝大小的判斷與選擇、切取術(shù)式，以及供體安全性等加以綜述。 結(jié)果供肝移植物大小是影響供體安全性與受體預(yù)后的關(guān)鍵因素，臨床有帶肝中靜脈的左半肝移植、含左側(cè)尾葉的擴(kuò)大左半肝移植、右半肝移植以及帶肝中靜脈的擴(kuò)大右半肝移植可供選擇，以使供肝與受體標(biāo)準(zhǔn)肝大小之比（GW/ESLW）≥30%，供肝與受體體重之比（GW/BW）≥0.8%。結(jié)論根據(jù)GW/ESLW以及GW/BW預(yù)測(cè)值，結(jié)合肝臟解剖特點(diǎn)，選擇合理的供肝切除術(shù)是具有重要的臨床意義。

引用本文： 姚輝華,文天夫,綜述,嚴(yán)律南,審校. 成人活體部分肝移植的臨床抉擇. 中國(guó)普外基礎(chǔ)與臨床雜志, 2003, 10(4): 411-414. doi: 復(fù)制

1. Seaberg EC, Belle SH, Beriger KC, et al. Liver transplantation in the United States from 1987-1998: Updated results from the PittUNOS liver transplant registry. In: Cecka JM, Teraski PI, eds. Clinical transplants 1998 [M]. Los Angeles: UCLA Typing Laboratory, 1999∶17-37.
2. Bravata DM, Olkin I, Barnato AE, et al. Healthrelated quality of life after liver transplantation: a metaanalysis [J]. Liver Transpl Surg, 1999; 5(4)∶318.
3. Harper AM, Rosendale JD. The UNOS open waiting list and donor registry. In: Cecka JM, Terasaki PI, eds. Clinical Transplants 1997 [M]. UCLA Typing Laboratory, 1998∶61-80.
4. Raia S, Nery JR, Mies S. Liver transplantation from live donors [J]. Lancet, 1989: 2(8661)∶497.
5. Hashikura Y, Kawasaki S, Terada M, et al. Longterm results of livingrelated donor liver graft transplantation: a singlecenter analysis of 110 transplants [J]. Transplantation, 2001; 72(1)∶95.
6. Haberal M, Buyukpamukcu N, Telatar H, et al. Segmental living liver transplantation in children and adults [J]. Transplant Proc, 1992; 24(6)∶2687.
7. Hashikura Y, Makuuchi M, Kawasaki S, et al. Successful livingrelated partial liver transplantation to an adult patient [J]. Lancet, 1994; 343(8907)∶1233.
8. Lo CM, Gertsch, Fan ST. Living unrelated liver transplantation between spouses for fulminant hepatic failure [J]. Br J Surg, 1995； 82(8)∶1037.
9. Sugawara Y, Makuuchi M, Takayama T, et al. Smallforsize grafts in livingrelated liver transplantation [J]. J Am Coll Surg, 2001; 192(4)∶510.
10. Renz JF, Busutti RW. Adulttoadult living donor liver transplantation a critical analysis [J]. Seminar in liver disease. 2000; 20(4)∶411.
11. Higashiyama H, Yamaguchi T, Mori K, et al. Graft size assessment by preoperative computed tomography in living related partial liver transplantation [J]. Br J Surg, 1993; 80(4)∶489.
12. Cheng YF, Chen CL, Huang TL, et al.Single imaging modality resonance imaging [J]. Transplantation, 2001; 72(9)∶1527.
13. Urata K, Kawasaki S, Matsunami H, et al.Calculation of child and adult standard liver volume for liver transplantation [J]. Hepatology, 1995; 21(5)∶1317.
14. Kawaski S, Makuuchi M, Ishizone S, et al. Liver regeneration in recipients and donors after transplantation [J]. Lancet, 1992; 339(8793)∶580.
15. Stone HH, Long WD, Smith RB 3rd, et al. Physiological considerations in major hepatic resections [J]. Am J Surg, 1969; 117(1)∶78.
16. Emond JC, Renz JF, Ferrell LD, et al. Functional analysis of grafts from living donors: implications for the treatment of older recipients [J]. Ann Surg, 1996; 224(4)∶544.
17. Lo CM, Fan ST, Liu CL, et al. Minimum graft size for successful living donor liver transplantation [J]. Transplantation, 1999; 68(8)∶1112.
18. BenHain M, Emre S, Facciuto M, et al. Critical graft size in adulttoadult living donor liver transplantation, the impact of the recipient disease [J]. Liver Transpl, 2001; 7(11)∶948.
19. Fan ST, Lo CM, Liu CL, et al. Safety of donors in liver donor liver transplantation using right lobe grafts [J]. Arch Surg, 2000; 135(3)∶336.
20. Kiuchi T, Kasahara M, Uryuhara K, et al. Impact of graft size mismatching on graft prognosis in liver transplantation from living donors [J]. Transplantation, 1999; 67(2)∶ 321.
21. Hiatt JR, Gabby J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases [J]. Ann Surg, 1994; 220(1)∶50.
22. Bismuth H. Surgical anatomy and anatomical surgery of the liver [J]. World J Surg, 1982; 6(1)∶3.
23. Marcos A, Fisher RA, Ham JM, et al. Liver regeneration and function in donor and recipient after right lobe adult living donor liver transplantation [J]. Transplantation, 2000; 69(7)∶1375.
24. Reichert PR, Renz JF, D’Albuquerque LA, et al. Surgical anatomy of the left lateral segment as applied to livingdonor and splitliver transplantation： a clinicopathologic study [J]. Ann Surg, 2000; 232(5)∶658.
25. Miyagawa S, Hashikura Y, Miwa S, et al. Concomitant caudate lobe resection as an option for donor hepatectomy in adult living related liver transplantation [J]. Transplantation, 1998; 66(5)∶661.
26. Takayama T, Makuuchi M, Kubota K, et al.Livingrelated transplantation of left liver plus caudate lobe [J]. J Am Coll Surg, 2000; 190(5)∶635.
27. Kawasaki S, Hashikura Y, Ikegami T, et al. Indications and needs for livingrelated transplantation in adults [J]. J Gastroenterol Hepatol, 2000; 15(Suppl)∶E175.
28. Yamaoka Y, Washida M, Honda K, et al.Liver transplantation using a right lobe graft from a living related donor [J]. Transplantation, 1994; 57(7)∶1127.
29. Lo CM, Fan ST, Liu CL, et al. Adulttoadult living donor transplantation using extended right lobe grafts [J]. Ann Surg, 1997; 226(3)∶261.
30. Marcos A, Fisher RA, Han JM, et al.Right lobe living donor liver transplantation [J]. Transplantation, 1999; 68(6)∶798.
31. Sakamoto S, Uemoto S, Uryuhara K, et al. Graft size assessment and analysis of donors for living donor liver transplantation using right lobe [J]. Transplantation, 2001; 71(10)∶1407.
32. Villa VH, Chen CL, Chen YS, et al. Right lobe living donor liver grafting addressing the middle hepatic vein controversy [J]. Am J Transplant, 2001; 1(2)∶261.
33. Fan ST, Lo CM, Liu CL. Technical refinement in adulttoadult living donor liver transplantation using right lobe graft [J]. Ann Surg, 2000; 231(1)∶126.
34. Sugawara Y, Makuuchi M, Takayama T, et al. Right lateral sector graft in adult livingrelated liver transplantation [J]. Transplantation, 2002; 73(1)∶111.
35. Sadan DL. Current status of partial liver transplantation in adults from cadaveric and living donors. In: Willis C, Maddery , Eugene R, eds. Transplantation of liver[M]. third ed. Philadephia: Sorrell. Lippincott Williams & Wilkin, 2001∶65-78.
36. Broelsch CE, Malago M, Testa G, et al. Living donor liver transplantation in adults: outcome in Europe [J]. Liver Transpl, 2000; 6(6 Suppl 2)∶S64.
37. Fair JH, Johnson MW, Gerber DA. Adulttoadult living donor liver transplantation using right lobe: Single center experience [J]. Am J Transplant, 2001; 1(2)∶316.
38. Malago M, Rogiers X, Burdelski M, et al. Living related liver transplantation: 36 cases at the University of Hamberg [J]. Transplant Proc, 1994; 26(6)∶3620.
  1. 1. Seaberg EC, Belle SH, Beriger KC, et al. Liver transplantation in the United States from 1987-1998: Updated results from the PittUNOS liver transplant registry. In: Cecka JM, Teraski PI, eds. Clinical transplants 1998 [M]. Los Angeles: UCLA Typing Laboratory, 1999∶17-37.
  2. 2. Bravata DM, Olkin I, Barnato AE, et al. Healthrelated quality of life after liver transplantation: a metaanalysis [J]. Liver Transpl Surg, 1999; 5(4)∶318.
  3. 3. Harper AM, Rosendale JD. The UNOS open waiting list and donor registry. In: Cecka JM, Terasaki PI, eds. Clinical Transplants 1997 [M]. UCLA Typing Laboratory, 1998∶61-80.
  4. 4. Raia S, Nery JR, Mies S. Liver transplantation from live donors [J]. Lancet, 1989: 2(8661)∶497.
  5. 5. Hashikura Y, Kawasaki S, Terada M, et al. Longterm results of livingrelated donor liver graft transplantation: a singlecenter analysis of 110 transplants [J]. Transplantation, 2001; 72(1)∶95.
  6. 6. Haberal M, Buyukpamukcu N, Telatar H, et al. Segmental living liver transplantation in children and adults [J]. Transplant Proc, 1992; 24(6)∶2687.
  7. 7. Hashikura Y, Makuuchi M, Kawasaki S, et al. Successful livingrelated partial liver transplantation to an adult patient [J]. Lancet, 1994; 343(8907)∶1233.
  8. 8. Lo CM, Gertsch, Fan ST. Living unrelated liver transplantation between spouses for fulminant hepatic failure [J]. Br J Surg, 1995； 82(8)∶1037.
  9. 9. Sugawara Y, Makuuchi M, Takayama T, et al. Smallforsize grafts in livingrelated liver transplantation [J]. J Am Coll Surg, 2001; 192(4)∶510.
  10. 10. Renz JF, Busutti RW. Adulttoadult living donor liver transplantation a critical analysis [J]. Seminar in liver disease. 2000; 20(4)∶411.
  11. 11. Higashiyama H, Yamaguchi T, Mori K, et al. Graft size assessment by preoperative computed tomography in living related partial liver transplantation [J]. Br J Surg, 1993; 80(4)∶489.
  12. 12. Cheng YF, Chen CL, Huang TL, et al.Single imaging modality resonance imaging [J]. Transplantation, 2001; 72(9)∶1527.
  13. 13. Urata K, Kawasaki S, Matsunami H, et al.Calculation of child and adult standard liver volume for liver transplantation [J]. Hepatology, 1995; 21(5)∶1317.
  14. 14. Kawaski S, Makuuchi M, Ishizone S, et al. Liver regeneration in recipients and donors after transplantation [J]. Lancet, 1992; 339(8793)∶580.
  15. 15. Stone HH, Long WD, Smith RB 3rd, et al. Physiological considerations in major hepatic resections [J]. Am J Surg, 1969; 117(1)∶78.
  16. 16. Emond JC, Renz JF, Ferrell LD, et al. Functional analysis of grafts from living donors: implications for the treatment of older recipients [J]. Ann Surg, 1996; 224(4)∶544.
  17. 17. Lo CM, Fan ST, Liu CL, et al. Minimum graft size for successful living donor liver transplantation [J]. Transplantation, 1999; 68(8)∶1112.
  18. 18. BenHain M, Emre S, Facciuto M, et al. Critical graft size in adulttoadult living donor liver transplantation, the impact of the recipient disease [J]. Liver Transpl, 2001; 7(11)∶948.
  19. 19. Fan ST, Lo CM, Liu CL, et al. Safety of donors in liver donor liver transplantation using right lobe grafts [J]. Arch Surg, 2000; 135(3)∶336.
  20. 20. Kiuchi T, Kasahara M, Uryuhara K, et al. Impact of graft size mismatching on graft prognosis in liver transplantation from living donors [J]. Transplantation, 1999; 67(2)∶ 321.
  21. 21. Hiatt JR, Gabby J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases [J]. Ann Surg, 1994; 220(1)∶50.
  22. 22. Bismuth H. Surgical anatomy and anatomical surgery of the liver [J]. World J Surg, 1982; 6(1)∶3.
  23. 23. Marcos A, Fisher RA, Ham JM, et al. Liver regeneration and function in donor and recipient after right lobe adult living donor liver transplantation [J]. Transplantation, 2000; 69(7)∶1375.
  24. 24. Reichert PR, Renz JF, D’Albuquerque LA, et al. Surgical anatomy of the left lateral segment as applied to livingdonor and splitliver transplantation： a clinicopathologic study [J]. Ann Surg, 2000; 232(5)∶658.
  25. 25. Miyagawa S, Hashikura Y, Miwa S, et al. Concomitant caudate lobe resection as an option for donor hepatectomy in adult living related liver transplantation [J]. Transplantation, 1998; 66(5)∶661.
  26. 26. Takayama T, Makuuchi M, Kubota K, et al.Livingrelated transplantation of left liver plus caudate lobe [J]. J Am Coll Surg, 2000; 190(5)∶635.
  27. 27. Kawasaki S, Hashikura Y, Ikegami T, et al. Indications and needs for livingrelated transplantation in adults [J]. J Gastroenterol Hepatol, 2000; 15(Suppl)∶E175.
  28. 28. Yamaoka Y, Washida M, Honda K, et al.Liver transplantation using a right lobe graft from a living related donor [J]. Transplantation, 1994; 57(7)∶1127.
  29. 29. Lo CM, Fan ST, Liu CL, et al. Adulttoadult living donor transplantation using extended right lobe grafts [J]. Ann Surg, 1997; 226(3)∶261.
  30. 30. Marcos A, Fisher RA, Han JM, et al.Right lobe living donor liver transplantation [J]. Transplantation, 1999; 68(6)∶798.
  31. 31. Sakamoto S, Uemoto S, Uryuhara K, et al. Graft size assessment and analysis of donors for living donor liver transplantation using right lobe [J]. Transplantation, 2001; 71(10)∶1407.
  32. 32. Villa VH, Chen CL, Chen YS, et al. Right lobe living donor liver grafting addressing the middle hepatic vein controversy [J]. Am J Transplant, 2001; 1(2)∶261.
  33. 33. Fan ST, Lo CM, Liu CL. Technical refinement in adulttoadult living donor liver transplantation using right lobe graft [J]. Ann Surg, 2000; 231(1)∶126.
  34. 34. Sugawara Y, Makuuchi M, Takayama T, et al. Right lateral sector graft in adult livingrelated liver transplantation [J]. Transplantation, 2002; 73(1)∶111.
  35. 35. Sadan DL. Current status of partial liver transplantation in adults from cadaveric and living donors. In: Willis C, Maddery , Eugene R, eds. Transplantation of liver[M]. third ed. Philadephia: Sorrell. Lippincott Williams & Wilkin, 2001∶65-78.
  36. 36. Broelsch CE, Malago M, Testa G, et al. Living donor liver transplantation in adults: outcome in Europe [J]. Liver Transpl, 2000; 6(6 Suppl 2)∶S64.
  37. 37. Fair JH, Johnson MW, Gerber DA. Adulttoadult living donor liver transplantation using right lobe: Single center experience [J]. Am J Transplant, 2001; 1(2)∶316.
  38. 38. Malago M, Rogiers X, Burdelski M, et al. Living related liver transplantation: 36 cases at the University of Hamberg [J]. Transplant Proc, 1994; 26(6)∶3620.