• 四川大學(xué)華西醫(yī)院肝臟及周圍血管外科（成都 610041）;

目的 探討活體肝移植受體圍手術(shù)期常規(guī)肝功能指標(biāo)、肝臟儲(chǔ)備功能和肝臟體積增長(zhǎng)動(dòng)態(tài)變化及其與患者近期臨床結(jié)局的關(guān)系。
方法 收集30例受體術(shù)前基本資料，對(duì)圍手術(shù)期常規(guī)肝功能指標(biāo)、吲哚氰綠（ICG）血漿清除率（K）、CT肝體積以及術(shù)后近期（3個(gè)月內(nèi)）的并發(fā)癥情況進(jìn)行分析。
結(jié)果 供肝重和受體體重比（GRBW）為0.63%～1.43%。受體術(shù)中移植肝臟體積為(638±103) ml，術(shù)后7、30及90 d移植肝臟體積分別增長(zhǎng)至(1 096±152) ml、(1 163±138) ml及(1 158±140) ml，均大于術(shù)中的體積（P lt;0.001），但術(shù)后各時(shí)間點(diǎn)肝臟體積間差異均無統(tǒng)計(jì)學(xué)意義（P gt;0.05）。受體術(shù)后3、7、30和90 d的KICG值逐漸升高〔(0.177±0.056)/min、(0.183±0.061)/min、(0.200±0.049)/min及(0.209±0.050)/min〕，均高于術(shù)前值〔(0.123±0.067)/min〕，差異均有統(tǒng)計(jì)學(xué)意義（P=0.006,P=0.002,P lt;0.001,P lt;0.001)。以供體術(shù)前KICG值(0.228±0.036)/min為基線，受體術(shù)后3 d和7 d的KICG值低于基線值（P=0.004，P=0.015），而術(shù)后30 d和90 d的KICG值已接近基線值(P=0.355,P=0.915)。根據(jù)術(shù)后14 d總膽紅素值將受體分為肝功能良好組（n=23）和肝功能不全組（n=7），與肝功能良好組相比，肝功能不全組術(shù)后3 d的KICG值明顯降低（P=0.001）。
結(jié)論 術(shù)后7 d是活體肝移植受體肝臟體積增長(zhǎng)的活躍期; 受體肝臟儲(chǔ)備功能的恢復(fù)要早于體積的恢復(fù)。ICG排泄試驗(yàn)可作為活體肝移植術(shù)后受體移植肝功能及預(yù)后的早期預(yù)測(cè)指標(biāo)。

引用本文： 尹杰,李波,杜正貴,馮曦,魏永剛,李甫強(qiáng),嚴(yán)律南,文天夫,唐荔. 活體肝移植術(shù)后受體肝臟儲(chǔ)備功能和體積變化研究. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(8): 789-794. doi: 復(fù)制

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1. Marcos A, Fisher RA, Ham JM, et al. Liver regeneration and function in donor and recipient after right lobe adult to adult living donor liver transplantation [J]. Transplantation, 2000; 69(3): 13751379.
2. Pomfret EA, Pomposelli JJ, Lewis WD, et al. Live donor adult liver transplantation using right lobe grafts: donor evaluation and surgical outcome [J]. Arch Surg, 2001; 136(4): 425433.
3. Pomfret EA, Pomposelli JJ, Gordon FD, et al. Liver regeneration and surgical outcome in donors of rightlobe liver grafts [J]. Transplantation, 2003; 76(1): 510.
4. Humar A, Kosari K, Sielaff TD, et al. Liver regeneration after adult living donor and deceased donor splitliver transplants [J]. Liver Transpl, 2004; 10(3): 374378.
5. Kawasaki S, Makuuchi M, Ishizone S, et al. Liver regeneration in recipients and donors after transplantation [J]. Lancet, 1992; 339(8793): 580581.
6. Kawasaki S, Makuuchi M, Matsunami H, et al. Living related liver transplantation in adults [J]. Ann Surg, 1998； 227(2): 269274.
7. Pascher A, Sauer IM, Walter M, et al. Donor evaluation, donor risks, donor outcome, and donor quality of life in adulttoadult living donor liver transplantation [J]. Liver Transpl, 2002; 8(9): 829837.
8. Akamatsu N, Sugawara Y, Tamura S, et al. Regeneration and function of hemiliver graft: right versus left [J]. Surgery, 2006; 139(6): 765772.
9. 杜正貴, 李波, 馮曦, 等. 脈搏染料光密度法吲哚氰綠排泄試驗(yàn)對(duì)評(píng)價(jià)肝癌切除術(shù)后肝功能不全的價(jià)值 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(2): 133136.
10. Maetani Y, Itoh K, Egawa H, et al. Factors influencing liver regeneration following livingdonor liver transplantation of the right hepatic lobe [J]. Transplantation 2003; 75(1): 97102.
11. Jochum C, Beste M, Penndorf V, et al. Quantitative liver function tests in donors and recipients of living donor liver transplantation [J]. Liver Transpl, 2006; 12(4): 544549.
12. Faybik P, Hetz H. Plasma disappearance rate of indocyanine green in liver dysfunction [J]. Transplant Proc, 2006; 38(3): 801802.
13. 路濤, 周翔平, 陳心足, 等. 肝炎后肝硬變病肝儲(chǔ)備功能與其體積變化研究 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2006; 13(6): 729732.
14. Hori T, Iida T, Yagi S, et al. KICG value, a reliable realtime estimator of graft function, accurately predicts outcomes in adult livingdonor liver transplantation [J]. Liver Transpl, 2006; 12(4): 605613.
15. Piscaglia F, Zironi G, Gaiani S, et al. Systemic and splanchnic hemodynamic changes after liver transplantation for cirrhosis: a longterm prospective study [J]. Hepatology, 1999; 30(1): 5864.
16. Navasa M, Feu F, GarcíaPagán JC, et al. Hemodynamic and humoral changes after liver transplantation in patients with cirrhosis [J]. Hepatology, 1993; 17(3): 355360.
17. Thevananther S, Sun H, Li D, et al. Extracellular ATP activates cjun Nterminal kinase signaling and cell cycle progression in hepatocytes [J]. Hepatology, 2004; 39(2): 393402.
18. Eguchi S, Yanaga K, Sugiyama N, et al. Relationship between portal venous flow and liver regeneration in patients after living donor rightlobe liver transplantation [J]. Liver Transpl, 2003; 9(6): 547551.
19. Niemann CU, Yost CS, Mandell S, et al. Evaluation of the splanchnic circulation with indocyanine green pharmacokinetics in liver transplant patients [J]. Liver Transpl, 2002; 8(5): 476481.
20. Niiya T, Murakami M, Aoki T, et al. Immediate increase of portal pressure, reflecting sinusoidal shear stress, induced liver regeneration after partial hepatectomy [J]. J Hepatobiliary Pancreat Surg, 1999; 6(3): 275280.
21. Kelly DM, Demetris AJ, Fung JJ, et al. Procine partial liver transplantation: a novel model of the “smallforsize” liver graft [J]. Liver Transpl, 2004; 10(2): 253263.
  1. 1. Marcos A, Fisher RA, Ham JM, et al. Liver regeneration and function in donor and recipient after right lobe adult to adult living donor liver transplantation [J]. Transplantation, 2000; 69(3): 13751379.
  2. 2. Pomfret EA, Pomposelli JJ, Lewis WD, et al. Live donor adult liver transplantation using right lobe grafts: donor evaluation and surgical outcome [J]. Arch Surg, 2001; 136(4): 425433.
  3. 3. Pomfret EA, Pomposelli JJ, Gordon FD, et al. Liver regeneration and surgical outcome in donors of rightlobe liver grafts [J]. Transplantation, 2003; 76(1): 510.
  4. 4. Humar A, Kosari K, Sielaff TD, et al. Liver regeneration after adult living donor and deceased donor splitliver transplants [J]. Liver Transpl, 2004; 10(3): 374378.
  5. 5. Kawasaki S, Makuuchi M, Ishizone S, et al. Liver regeneration in recipients and donors after transplantation [J]. Lancet, 1992; 339(8793): 580581.
  6. 6. Kawasaki S, Makuuchi M, Matsunami H, et al. Living related liver transplantation in adults [J]. Ann Surg, 1998； 227(2): 269274.
  7. 7. Pascher A, Sauer IM, Walter M, et al. Donor evaluation, donor risks, donor outcome, and donor quality of life in adulttoadult living donor liver transplantation [J]. Liver Transpl, 2002; 8(9): 829837.
  8. 8. Akamatsu N, Sugawara Y, Tamura S, et al. Regeneration and function of hemiliver graft: right versus left [J]. Surgery, 2006; 139(6): 765772.
  9. 9. 杜正貴, 李波, 馮曦, 等. 脈搏染料光密度法吲哚氰綠排泄試驗(yàn)對(duì)評(píng)價(jià)肝癌切除術(shù)后肝功能不全的價(jià)值 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(2): 133136.
  10. 10. Maetani Y, Itoh K, Egawa H, et al. Factors influencing liver regeneration following livingdonor liver transplantation of the right hepatic lobe [J]. Transplantation 2003; 75(1): 97102.
  11. 11. Jochum C, Beste M, Penndorf V, et al. Quantitative liver function tests in donors and recipients of living donor liver transplantation [J]. Liver Transpl, 2006; 12(4): 544549.
  12. 12. Faybik P, Hetz H. Plasma disappearance rate of indocyanine green in liver dysfunction [J]. Transplant Proc, 2006; 38(3): 801802.
  13. 13. 路濤, 周翔平, 陳心足, 等. 肝炎后肝硬變病肝儲(chǔ)備功能與其體積變化研究 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2006; 13(6): 729732.
  14. 14. Hori T, Iida T, Yagi S, et al. KICG value, a reliable realtime estimator of graft function, accurately predicts outcomes in adult livingdonor liver transplantation [J]. Liver Transpl, 2006; 12(4): 605613.
  15. 15. Piscaglia F, Zironi G, Gaiani S, et al. Systemic and splanchnic hemodynamic changes after liver transplantation for cirrhosis: a longterm prospective study [J]. Hepatology, 1999; 30(1): 5864.
  16. 16. Navasa M, Feu F, GarcíaPagán JC, et al. Hemodynamic and humoral changes after liver transplantation in patients with cirrhosis [J]. Hepatology, 1993; 17(3): 355360.
  17. 17. Thevananther S, Sun H, Li D, et al. Extracellular ATP activates cjun Nterminal kinase signaling and cell cycle progression in hepatocytes [J]. Hepatology, 2004; 39(2): 393402.
  18. 18. Eguchi S, Yanaga K, Sugiyama N, et al. Relationship between portal venous flow and liver regeneration in patients after living donor rightlobe liver transplantation [J]. Liver Transpl, 2003; 9(6): 547551.
  19. 19. Niemann CU, Yost CS, Mandell S, et al. Evaluation of the splanchnic circulation with indocyanine green pharmacokinetics in liver transplant patients [J]. Liver Transpl, 2002; 8(5): 476481.
  20. 20. Niiya T, Murakami M, Aoki T, et al. Immediate increase of portal pressure, reflecting sinusoidal shear stress, induced liver regeneration after partial hepatectomy [J]. J Hepatobiliary Pancreat Surg, 1999; 6(3): 275280.
  21. 21. Kelly DM, Demetris AJ, Fung JJ, et al. Procine partial liver transplantation: a novel model of the “smallforsize” liver graft [J]. Liver Transpl, 2004; 10(2): 253263.