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Objective To investigate the clinical value of the precision liver surgery in the liver graft procurement for pediatric living donor liver transplantation.Methods The clinical data of 58 living donors of left hepatic lobe graft who were admitted to the Renji Hospital of Shanghai Jiaotong University from December 2012 to January 2014 were retrospectively analyzed retrospectively from December 2012 to January 2014.All the donors donated voluntarily and gratuitously and were approved by the ethics committee of the hospital.All the donors received computed tomography (CT),and the two dimensional data were converted to three dimensional images for evaluating the intrahepatic bile ducts and blood vessles,and the typs of the left hepatic arteries and veins were determined.The donor's liver graft volume was assessed by CT before operation.The standard liver volume of the donors and the recipients,and the volume of liver to be reseeted and the total liver volume were measured.A virtual surgery was conducted for designing the actual surgery.The liver graft was resected with the precision liver surgery technique.Patients were followed up by the out-patient examination and phone call till April 2014.Results The results of CT angiography confirmed that 28 donors were with type Ⅰ left hepatic artery,10 with type Ⅱ left hepatic artery and 20 with type Ⅲ left hepatic artery; 35 patients were with type Ⅰ left hepatic vein and 23 with type Ⅱ left hepatic vein.The left-lobe volume estimated by CT was (243 ± 65) mL.Liver graft procurement was successfully carried out on the 58 donors,including 7 left hemihepatectomy and 51 left lateral lobectomy.Two donors received cholecystectomy concomitantly.The actual volume of liver resected was (255 ±59) mL,and the error rate of the liver volume to be resected was 4.94％.The weight of the liver graft to the body weight of the recipient was 3.3％ ± 1.0％.The operation time and the volume of blood loss were (260 ± 89) minutes and (181 ± 35)mL,respectively.One donor received red blood cell infusion of 2 U.The time for gastrointestinal function recovery was (2.0 ± 1.1) days,and the time of drainage tube pull-off was (3.0 ± 1.2) days.The duration of postoperative stay was (7 ± 3) days.The white blood cells,hemoglobin,alanine transaminase,aspartate transaminase,total bilirubin,direct bilirubin and albumin were at the normal levels at the discharge.Two donors were complicated by incisional bleeding and fat liquefaction,and they were cured by symptomatic treatment.All the donors were followed up for a median time of 8.7 months.The donors were recovered well without complications during the follow-up.Conclusions Liver graft procurement guided by precision liver surgery has the advantages of high accurate rate,little injury to the liver of the donors,few postoperative complications and quick recovery of the donors.
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Objective To investigate the clinical value of fast track surgery (FTS) in donor in liver transplantation.Methods The clinical data of 214 donors for liver transplantation at the Renji Hospital of Shanghai Jiaotong University from January 2006 to November 2011 were retrospectively analyzed.All donors were divided into FTS group and conventional group.From January 2006 to May 2009,73 donors who received conventional perioperative management were in the conventional group,and 141 donors who received FTS from May 2009 to November 2011 were in the FTS group.The recovery of the donors in the 2 groups was compared.All data were analyzed using the chi-square test or t test.Results The operation time,time to out-of-bed activity,time to postoperative exsufflation,time to bowel movement,and duration of postoperative hospital stay were (178 ±37) minutes,(1.6 ± 1.0) days,(2.9 ± 1.6) days,(3.1 ± 1.5) days and (5.9 ± 1.9) days in the FTS group,which were significantly shorter than (167 ± 33) minutes,(3.6 ± 1.4) days,(4.6 ± 2.3) days,(4.5 ± 1.4) days and (7.6 ± 1.5) days in the conventional group (t =2.115,77.138,6.504,6.913,6.970,P ＜ 0.05).The hospital costs of the FTS group and the conventional group were (1.8 ±0.6) × 104 yuan and (2.2 ±0.4) x 104 yuan,respectively,with a significant difference between the 2 groups (t =73.038,P ＜ 0.05).The volumes of operative blood loss of the FTS group and the conventional group were (130 ± 47)ml and (138 ± 46)ml,with no significant difference between the 2 groups (t =1.251,P ＞ 0.05).The rate of satisfaction of the donors in the FTS group and conventional group were 98.6％ (139/141) and 89.2％ (74/83),respectively,with a significant difference between the 2 groups (x2 =9.94,P ＜ 0.05).Conclusion FTS is safe,economical and can reduce stress,decrease hospital costs and promote early recovery of donors in liver transplantation.
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Objective To investigate the clinical choice on graft size and the type of donor's hepatectomy in adult living related partial liver transplantation. Methods The literatures in recent years on the donor's evaluation, the size of liver grafts, the types of donor hepatectomy and safety of donor in adult living related partial liver transplantation were reviewed.Results The size of liver graft is a crucial factor related to the safety of donor and the prognosis of the recipient. GW/ESLW≥30%, GW/BW≥0.8% may be the lowest limits. Left lobe contained middle hepatic vein, extended left lobe with left-side caudle lobe, right lobe or extended right lobe contained middle hepatic vein may be the practical choice.Conclusion It is important to make a reasonable choice of liver graft according to the estimation of GW/ESLW or GW/BW, and the anatomy of liver in adult living related partial liver transplantation.
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0.05). Compared with controlled central venous pressure (CVP) before and right after hepatectomy, CVP increased significantly (P