• 四川大學華西醫(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期常規(guī)肝功能指標、肝臟儲備功能和肝臟體積增長動態(tài)變化及其與患者近期臨床結局的關系。
方法 收集30例受體術前基本資料，對圍手術期常規(guī)肝功能指標、吲哚氰綠（ICG）血漿清除率（K）、CT肝體積以及術后近期（3個月內(nèi)）的并發(fā)癥情況進行分析。
結果 供肝重和受體體重比（GRBW）為0.63%～1.43%。受體術中移植肝臟體積為(638±103) ml，術后7、30及90 d移植肝臟體積分別增長至(1 096±152) ml、(1 163±138) ml及(1 158±140) ml，均大于術中的體積（P lt;0.001），但術后各時間點肝臟體積間差異均無統(tǒng)計學意義（P gt;0.05）。受體術后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〕，均高于術前值〔(0.123±0.067)/min〕，差異均有統(tǒng)計學意義（P=0.006,P=0.002,P lt;0.001,P lt;0.001)。以供體術前KICG值(0.228±0.036)/min為基線，受體術后3 d和7 d的KICG值低于基線值（P=0.004，P=0.015），而術后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，肝功能不全組術后3 d的KICG值明顯降低（P=0.001）。
結論 術后7 d是活體肝移植受體肝臟體積增長的活躍期; 受體肝臟儲備功能的恢復要早于體積的恢復。ICG排泄試驗可作為活體肝移植術后受體移植肝功能及預后的早期預測指標。

引用本文： 尹杰,李波,杜正貴,馮曦,魏永剛,李甫強,嚴律南,文天夫,唐荔. 活體肝移植術后受體肝臟儲備功能和體積變化研究. 中國普外基礎與臨床雜志, 2010, 17(8): 789-794. doi: 復制

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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對評價肝癌切除術后肝功能不全的價值 [J]. 中國普外基礎與臨床雜志, 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備功能與其體積變化研究 [J]. 中國普外基礎與臨床雜志, 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對評價肝癌切除術后肝功能不全的價值 [J]. 中國普外基礎與臨床雜志, 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備功能與其體積變化研究 [J]. 中國普外基礎與臨床雜志, 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.