肝移植分為同種異體肝移植(allotransplantation of the liver)和異種肝移植(xenotransplantation of the liver),迄今,按供肝植入位置、供肝的體積、供肝來源和供肝植入方式,同種異體肝移植的術(shù)式可分為如下幾種:
1.異位肝移植(heterotopic liver transplantation):保留受體原肝,將供肝植入受體體腔的其他部位,如在脾床上、盆腔或脊柱旁部位。
2.原位肝移植(orthotopic liver transplantation):切除受體肝,將供肝植入受體原肝部位。原位肝移植又可分為以下5種(圖1-1)
圖1-1 肝移植分類
。1)標準式肝移植:供肝大小和受體腹腔大小相匹配,按原血管解剖將整個供肝植入受體的原肝部位。
。2)減體積性質(zhì)肝移植(reduced-sized liver transplantation):在受體腹腔較小而供肝體積相對較大,受體體腔不能容納的情況下,切除部分供肝后再原位植入。
。3)活體部分肝移植(living related donor liver transplantation):從活體上切取肝左外葉作為供肝植入受體的原肝部位。
。4)劈離式肝移植(split liver transplantation):將供肝分成兩半,分別移值給兩個受體。
。5)原位輔助性肝移植(orthotopic auxiliary liver transplantation):保留受體的部分肝臟,將減體積后的供肝植入病肝切除部分的位置(圖1-2)。
背馱式技術(shù)(orthotopic auxiliary liver transplantation):切除病肝時,保留受體的肝后下腔靜脈,將供肝上下腔靜脈與受體的3條肝靜脈或肝中、肝左靜脈所形成的共同開口相吻合,或供、受體肝后下腔靜脈行側(cè)吻合,重建肝臟的血液流出道,結(jié)扎供肝的肝后下腔靜脈。此技術(shù)不論是全肝移植或減體積性減體積性肝植均可采用,在活體部分肝移植時必須采用背馱式技術(shù)(圖1-3)。
圖1-2 原位輔助性肝移植
切除病肝左外葉,取供肝左外葉值入
1.病肝2.新肝3.下腔靜脈4.門靜脈5.肝動脈
圖1-3 背馱式供肝植入技術(shù)
參考文獻
1.Welch CS Anote on transplantation of the whole liver in dogs.Transplant Bull,1955,2:54
2.Starzl TE,Marchioro TL,Huntley Rt et al.Experiment and clinical homotransplantations of liver.Ann NY Acad Sci,1964,120:739
3.Starzl TE,Brettschneider L,Putnam CW.Transplantation of the liver.In:Popper H,Schaffner F eds.Progress in liver disease.Vol 3.New York:Grune &Stratton,1970:495-542
4.Calne RY.Liver transplantation:The Cambridge-King’s College Hospital experience.New York:Grunne&.Stratton,1983:339
5.Calne RY,Roues K,White DJG et al.Cyclosporine A initially
as the only immunosuppressant in 34 patients of cadaveric organs,32 kidneys,2pancreases,and 2 livers.Lancet,1979,2:1033
6.Starzl TE,Weil R Ⅲ,Iwatsuki S et al .The use of cyclosporine A and prednisone on cadaver kidney liver transplantation .Surg Gynecol Obstet,1980,151:17
7.Pappas SC,Rouch DA ,Stevens LH.New technipues for liver transplantation:reduced-sized,living-related and auxiliarytransplantation,Scand JGastroenterol,1995,208(Suppl):97
8.Fung JJ,Todo S,Jain A et al.Conversion from cyclosporine to FK506 in liver allograft recipients with cyclosporine-related complications,Transplant Proc,1990,22:6
9.Starzl TE,Fung JJ,Tzakis A et al .Baboon-to-human liver transplantation Lancet,1993,341:65
10.Dixit v,Gitnick G.Artificial liver support:state of the art .Scand Gastroenterol ,1996,220(Suppl):101
11.Lee H Vacanti JP.Liver transplantation and its long-term management,Pediatr Clin North Am ,1996,43:99