上海交通大学学报（医学版）

›› 2012, Vol. 32 ›› Issue (9): 1198-.doi: 10.3969/j.issn.1674-8115.2012.09.014

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多模式部分肝移植关键技术及其临床应用

李宏为, 彭承宏, 沈柏用, 陈拥军, 邓侠兴, 詹 茜, 陈 皓   

  1. 上海交通大学 医学院附属瑞金医院外科及消化外科研究所, 上海 200025
  • 出版日期:2012-09-28 发布日期:2012-09-29
  • 作者简介:李宏为(1939—), 男, 教授, 主任医师, 博士生导师, 现任门脉高压症全国学组副主任委员, 原上海交通大学医学院附属瑞金医院院长兼外科主任；电子信箱: hwli@263.net。
  • 基金资助:

    上海市科委重点项目（09411952100）

Key technologies and clinical applications of multimodality partial liver transplantation

LI Hong-wei, PENG Cheng-hong, SHEN Bai-yong, CHEN Yong-jun, DENG Xia-xing, ZHAN Xi, CHEN Hao   

  1. Research Institute of Digestive Surgery and Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
  • Online:2012-09-28 Published:2012-09-29

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摘要：

针对目前全世界肝脏移植的瓶颈问题——供肝匮乏，课题组提出了一种新的肝移植方式——部分肝移植，取得了一系列原创性成果。与国内外同类研究比较，主要有以下发现和创新点：① 确立了对移植物的选择标准和右半肝移植物静脉回流的重建方式；②比较了带或不带肝中静脉的右半肝移植物的活体肝移植的术后结果，确定了带肝中静脉的右半肝移植物的安全性和必要性；③首次在国内开展劈离式肝移植治疗终末期肝病患者，并保持国内单中心最大病例数；④首次在国内开展不同血型两供一受活体肝移植并获成功，该手术方式为受体提供了更大重量的肝脏，最大限度地保证了供体的安全；⑤在国际上率先报道了中国肝移植人群免疫抑制剂霉酚酸药代动力学变化规律，首次建立了霉酚酸完全暴露的简化计算公式，并首次比较了活体肝移植和全肝移植霉酚酸药代动力学的差异。该研究成果获2010年国家科技进步二等奖。

关键词: 多模式, 肝移植, 供体, 霉酚酸

Abstract:

Shortage of donors has been remaining a major obstacle in organ transplantation around the world for a long time. In the current study, a new pattern of liver transplantation, named partial liver transplantation, was established as a solution for deficiency of hepatic donor and a serial of original results has been achieved. After review and comparison with similar domestic and overseas investigations, some innovations and discoveries were found in this method. ①Establishment of the selection criteria of graft and the reconstruction pattern of right hemi hepatic grafts venous drainage. ②In living donor liver transplantation, the safety and necessity of using right hemi hepatic graft with middle hepatic vein in right hemi hepatic graft were determined by comparing the operational results with or without middle hepatic vein. ③This is the first time in China that split liver transplantation was adopted for the treatment of terminal liver diseases. The largest number of cases has been maintained in a single domestic transplantation center. ④It is also the first in China that one case of living donor liver transplantation using dual grafts was carried out successfully with non-identical blood types between donor and recipient. This modus operandi could provide recipient with a greater weight of liver graft and maximum safety of donor as well. ⑤The pharmacokinetics and pharmacodynamics of mycophenolic acid in Chinese liver transplant recipients were reported for the first time in this report. By monitoring of the full exposure of mycophenolic acid, abbreviated sampling strategy was adopted to determine the area under the curve. In addition, the pharmacokinetics of mycophenolic acid and its metabolites were compared between living donor liver transplant recipients and deceased donor liver transplant recipients. The research achievement has been awarded the second prize of National Science and Technology Progress.

Key words: multimodality, liver transplantation, donor, mycophenolic acid