Chan SC, Fan ST, Lo CM, Liu CL, Wong J
肝病研究中心和外科，香港大学，薄扶林道，香港，中国

目标：界定捐赠者肝右叶切除的现行标准，包括成人-成人活体肝移植肝中静脉。

背景资料简介：在捐赠者手术中，发病率和死亡率是不可避免的。来自成熟中心的结果能够更准确的界定该手术的真实影响。

患者和方法：1996年5月9日至2005年4月13日期间，连续200名捐赠者在香港大学医学中心进行了肝右叶切除手术。除一例捐赠者之外，所有的右叶肝脏均包括肝中静脉。我们比较了捐赠者的特征、手术时间、失血情况、住院时间、实验室检查结果和通过Clavien系统划分的四个阶段的并发症（每个连续50例）。

结果：各阶段的捐赠者特征大致相同，且手术疗效逐步改善。从第1阶段至第4阶段，手术时间从598分钟（范围为378—932分钟）减少为391分钟（范围为304—635分钟）。失血情况也从第1阶段的500mL（范围为200—1600mL）降低为第4阶段的251mL（范围为95—595mL）。并发症的总体发生率为20.5%（200例中出现41例）。并发症在第1阶段至第4阶段的发病率分别为34%、16%、16%和16%。最常发生的并发症为I级（41例中出现24例，占58.5%）。术后10周，一名捐赠者因duodenocaval瘘恶化死亡，因此捐赠者死亡率为0.5%（200例中出现1例）。

结论：本研究证实了捐赠者活体肝右叶切除术的发病率和死亡率分别为20%和0.5%。以上数据为捐赠者的咨询提供了参考，并且为目前阶段的肝右叶切除术界定了标准。

Toward current standards of donor right hepatectomy for adult-to-adult live donor liver transplantation through the experience of 200 cases
Chan SC, Fan ST, Lo CM, Liu CL, Wong J
Centre for the Study of Liver Disease and Department of Surgery, University of Hong Kong, Pokfulam, Hong Kong, China.

OBJECTIVE: To define the current standards of donor right hepatectomy, including the middle hepatic vein for adult-to-adult live donor liver transplantation.

SUMMARY BACKGROUND DATA: Donor morbidity and mortality are inevitable given the ultra-major nature of the donor operation. Results from a matured center could define the true impact of this donor procedure most accurately.

PATIENTS AND METHODS: From May 9, 1996 to April 13, 2005, 200 consecutive donors underwent donor right hepatectomy at the University of Hong Kong Medical Center. All right liver grafts except one included the middle hepatic vein. Donor characteristics, operation time, blood loss, hospital stay, laboratory results, and complications graded by Clavien's classification divided into four eras (each consecutive 50 cases) were compared.

RESULTS: Donor characteristics of the four eras were generally comparable. Operative outcomes improved progressively through the four eras. From era 1 to era 4, operation time decreased from 598 minutes (range, 378-932 minutes) to 391 minutes (range, 304-635 minutes). Blood loss also decreased from 500 mL (200-1600 mL) of era 1 to 251 mL (range, 95-595 mL) of era 4. Overall complication rate was 20.5% (41 of 200). Complications rates from eras 1 to 4 were 34%, 16%, 16%, and 16%, respectively. The most common complications were of grade I (24 of 41, 58.5%). A late donor death occurred in era 4 from the development of a duodenocaval fistula 10 weeks postoperation, giving a donor mortality of 0.5% (1 of 200).

CONCLUSIONS: This study validated the estimated morbidity and mortality of donor right hepatectomy of 20% and 0.5%, respectively. The data provide reference for counseling potential donors and setting the standards of donor right hepatectomy in the current era.

Ann Surg. 2007 Jan;245(1):110-7.
PMID: 17197973 [PubMed - indexed for MEDLINE]

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