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目的总结亲属活体供肝移植治疗肝豆状核变性时选择供者的经验。方法29例肝豆状核变性患者接受亲属活体供肝移植,共有70名供者入选筛查,筛查内容包括肝功能、血清肝炎标记物、肝体积的估测及肝血管和胆管系统解剖结构的预测,以及年龄、体型、供受者配型、伦理学方面的评估等。结果23名供者被排除,10名(43.5%)志愿者是因为受家庭、亲属和社会上的传统观念的影响而最终放弃捐肝意愿;6名(26.1%)因铜代谢指标异常,血清铜蓝蛋白<200mg/L,24h尿铜>100μg;4名(17.4%)因为脂肪肝;3名(13%)因为乙型肝炎。10例为右叶供肝,19例为左叶供肝。供肝重量与受者体重之比为(1.38±0.44)%。所有供者术后恢复正常生活。3名供者术后发生外科相关并发症,其中2例为一过性胆漏,经穿刺引流后治愈,1例为肝断面渗血,经保守治疗痊愈。结论影响供肝选择的主要因素有传统观念、供者铜代谢指标的异常、乙型肝炎及脂肪肝;而术前对供者进行全面评估及供肝切取技术的改进,是保证供者安全和供肝质量的关键。
Objective To summarize the experience of selecting donors when living donor liver transplantation for hepatolenticular degeneration. Methods Twenty-nine patients with hepatolenticular degeneration underwent donor living donor liver transplantation. A total of 70 donors were screened. The screening included liver function, markers of serum hepatitis, liver volume, and anatomy of the hepatic and biliary ducts Of predictions, as well as age, size, donor matching, ethical assessment. Results Twenty-three donors were excluded. Ten (43.5%) volunteers eventually gave up their willingness to donate their liver due to the influence of family, relatives and traditional beliefs. Six patients (26.1% Copper blue protein <200mg / L, 24h urine copper> 100μg; 4 (17.4%) because of fatty liver; 3 (13%) because of hepatitis B. 10 cases of right lobe liver supply, left hepatic lobe 19 cases. The ratio of donor liver weight to recipient body weight was (1.38 ± 0.44)%. All donors returned to normal life after surgery. Surgical complications occurred in 3 donors, of which 2 were transient biliary tracts and were cured by puncture and drainage. One patient had hemoperfusion on the liver and healed by conservative treatment. Conclusion The main factors influencing the selection of donor liver are the traditional concept, the abnormalities of donor’s copper metabolism index, hepatitis B and fatty liver. However, the preoperative assessment of donors and the improvement of hepatectomy technique are necessary to ensure donor safety and The key to liver quality.