探讨公民逝世后器官捐献原位劈离式肝移植(ISSLT)的临床疗效。

回顾性分析青岛大学附属医院器官移植中心2015年5月至2017年2月实施的10例ISSLT供、受者临床资料。10例供者均为中国Ⅰ类器官捐献，中位年龄33岁，脑死亡原因分别为脑外伤6例，脑出血4例；中位体质量指数22.8 kg/m²，ICU住院时间(3.8±2.1)d。经评估后按3种方式完成在体供肝劈离，产生20例具有独立解剖功能的供肝。10例ISSLT中，6对成人－儿童，4对成人－成人，移植物重量与受者体质量比为1.5%～2.7%。6对成人－儿童中，5对分别使用扩大右半肝和左外侧叶，1对分别使用左、右半肝；4对成人－成人分别使用左、右半肝。接受右侧肝叶的受者行经典原位肝移植，接受左侧肝叶的受者行背驮式肝移植。

供肝劈离手术时间(226±58) min，出血量(138±51) mL；供肝离体修整时间为(84±25) min。20例受者中，8例在外院手术，12例在我院手术。截至2017年9月，在本院手术的12例受者术后中位随访时间13.5个月，10例未发生出血、血管及胆道并发症，肝功能恢复顺利。2例出现胆道并发症，1例胆管吻合口轻度狭窄，经皮胆道支架植入好转；1例接受右三叶供肝的受者术后2周夹闭T管后出现少量胆漏，经引流后好转。5例接受右三叶供肝的受者中，1例术后移植肝Ⅳ段坏死，受者ALT升高，肝叶萎缩，2周后肝功能恢复正常；其余4例Ⅳ段门静脉重建的受者，术后肝功能均恢复较快。

ISSLT可以在循环状态稳定的脑死亡供者中顺利开展，在保证供肝质量的前提下，提高了供肝使用率。

To investigate the clinical effect of in-suit split liver transplantation (ISSLT) from donation after citizen′s death.

The clinical data of 10 cases of ISSLT donors and correlated recipients from May 2015 to February 2017 in Organ Transplantation Center of the Affiliated Hospital of Qingdao University were retrospectively analyzed. Ten donors were all donation after brain death, the median age of donors was 33 years old, 6 cases died of traumatic brain injury and 4 cases died of cerebral hemorrhage, the median body mass index was 22.8 kg/m² and the average time of ICU hospitalization was (3.8±2.1) d. Three kinds of methods were used to split the donor liver and produced 20 grafts which had independent anatomical function. There were 6 pairs of adult - children and 4 pairs of adult-adult in the above 10 cases of ISSLT, and the graft-to-recipient weight ratio were 1.5% to 2.7%.

The average time of in-suit splitting and amount of bleeding were (226±58) min and (138±51) mL, and the median time for donor liver repairment was (84±25) min. Twelve recipients got liver transplantation in our hospital. The median follow-up time of above 12 recipients was 13.5 months up to September 2017. Only 2 recipients occured with biliary complications after transplantation, including 1 case of bile duct mild anastomotic stenosis who improved after percutaneous biliary stenting, and another recipient who received right lobe liver graft had a small amout of bile leakage after T tube clipped 2 weeks after transplantation and improved after drainage.

ISSLT can be developed successfully in circulatory stable brain death donors, which can increased the utilization rate of liver grafts without graft quality reduction.