Abstract:

Objective To report one case of reduced-size liver transplantation in the treatment of children with congenital segment reported cases of biliary atresia. Methods Reduced monosegmental liver transplantation was performed for one patient suffered congenital biliary atresia in our hospital in March 2014. Thepatient was 5 months old and 7 kg in weight. His mother donated her left lateral liver. Due to graft-to-recipientweight ratio（GRWR）was too high（5.14%），the left lateral donor liver was harvested and further reduced size invitro. The diseased liver of patient was removed with the vena cava reserved，then orthotopic liver transplantation was performed. Results Donor operative time was 6.5 hours and total amount of bleeding was 150 ml，donor recoveredwell and discharged 1 week after operation. Recipient operative time was 8.5 hours with 50 minutes of an-hepaticperiod. Reduced-size graft was 260 g and GRWR was reduced to 3.71%. Intraoperative methylprednisolone inductionand tripleimmunosuppressive regimen（tacrolimus + mycophenolate mofetil + methylprednisolone）were applied forrecipient. Recipient condition was well and liver function return to normal level 25 days after operation. Abdominalultrasound suggest normal hemodynamics and increasing volume of graft liver. Recipient was discharged 35 days afteroperation and abdominal wound healed with A level. Both donor and recipient were followed up 6 months without any complications. Conclusion To prevent complications associated with large-for-size grafts，further graft reduction could be necessary to overcome the large-for-size graft syndrome，the reduced monosegmental liver transplantationis an safe and effective selection which was based on accurate preoperative radiological assessment of the graft andexcellent perioperative care and management to the patient.

摘要：

目的 报道 1 例减体积肝段移植治疗儿童先天性胆管闭锁的病例。方法 回顾性总结天津市第一中心医院 2014 年 3 月为 1 例先天性胆管闭锁的患儿进行的亲属活体肝移植术，患儿年龄 5 个月，体重7 kg，供体为患儿母亲，术中切取供肝重量为 360 g，移植物重量受体体重比（GRWR）偏大（5.14%），手术切取供体肝脏左外侧叶，并在体外对供肝进行减体积的肝切除，受体行保留下腔静脉的全肝切除术，然后行供肝原位移植。结果 供体手术时间为 6 小时 30 分钟，术中出血 150 ml，术后 1 周顺利恢复出院。受体手术时间为 8.5 小时，无肝期为 50 分钟 ；供肝重量为 360 g，减体积后为 260 g，GRWR 降低为 3.71%。免疫抑制采用术中甲泼尼龙诱导，术后三联免疫抑制方案（他克莫司 + 霉酚酸酯 + 甲泼尼龙）。受者术后25 天转氨酶及胆红素指标降至正常，腹部超声提示移植肝血管及血流未见异常，移植肝体积逐月增大。受者腹部伤口Ⅰ级愈合，于术后 35 天出院。肝移植术后随访 6 个月，供、受者均未出现任何并发症，受体术后体重迅速增加。结论 针对大体积供肝的儿童活体肝移植，采用减体积肝段移植是有效且安全的选择，前提是在术前对供肝血管影像学检查的准确评估以及受者围手术期的严格管理。