Yi NJ, Suh KS, Cho JY, Lee HW, Cho EH, Yang SH, Cho YB, Lee KU.
外科，首尔大学医学院，首尔，韩国。

与肝左叶切除相比，肝右叶切除（RH）捐赠者的发病率相对较高。因此，为了促进RH捐赠的成功率，有必要了较确切的发病率。然而，并发症的发病率根据个人发病率的不同而改变。

本研究采用对并发症严重程度的标准分类，前瞻性的分析了2002年1月至2004年7月期间连续的83例活体RHs肝供者。研究人员使用Clavien系统修订版对发病率进行分类：I级为轻微并发症；II级为潜在威胁生命的并发症，需要药物治疗；III级为需要有创介入治疗的并发症；IV级为引起器官功能衰竭的并发症，需要ICU管理；V级并发症会导致患者死亡。

我们对捐赠者进行了至少12周的随访，没有一例捐赠者出现死亡或relaparotomy。总体而言，83例患者中有65例（78.3%）出现了术后并发症，分别为I级并发症64例（77.1%）、II级11例（13.3%）、III级1例（1.2%）、IV级0例和 V级0例。最常见的I级并发症为血胆红素过多（n=31）和胸腔积液（n=31），胆漏为II级并发症（n=7）。在1年的术后随访中，92.7%捐赠者的胆红素和谷丙转氨酶水平正常。

总之，虽然大部分的不良事件程度均较轻微且具有自限性，78%的肝右叶捐赠者仍然有发病率。因此，关于捐赠者发病率的连续报道以及精细的手术、重病特别护理等因素是RH捐赠成功的关键。
Three-quarters of right liver donors experienced postoperative complications
Yi NJ, Suh KS, Cho JY, Lee HW, Cho EH, Yang SH, Cho YB, Lee KU.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
A donor right hepatectomy (RH) is associated with a higher rate of morbidity than a left hepatectomy. Therefore, the precise morbidity should be known to improve the success of donor RH implementation. However, the rate of complication varies according to the individual definition of morbidity.

This study prospectively analyzed the outcomes of 83 consecutive living donor RHs between January 2002 and July 2004 using a standardized classification of the severity of complications. The morbidity was classified using the modified Clavien system: grade I for minor complications; grade II for potentially life-threatening complications requiring pharmacological treatment; grade III for complications requiring invasive intervention; grade IV for complications causing organ dysfunction requiring intensive care unit management; and grade V complications resulting in the death of the patient.

The donors were followed-up regularly for at least 12 months. No donor death or relaparotomy was noted. Overall, 65 out of 83 donors (78.3%) experienced postoperative complications: grades I, II, III, IV, and V complications in 64 (77.1%), 11 (13.3%), 1 (1.2%), 0, and 0 patients, respectively. The most common grade I complications were hyperbilirubinemia (n = 31) and pleural effusion (n = 31), and bile leakage in grade II (n = 7). The bilirubin and alanine aminotransferase levels were normal in 92.7% of donors at the 1-year follow-up.

In conclusion, although most of these adverse events were minor and self-limited, 78% of right liver donors still experienced morbidity. Therefore, continuous standardized reporting of the donor morbidity as well as meticulous surgery and intensive care are essential for the success of donor RH implementation.

[责任编辑:刘聪]