Living partial liver transplantation is a method of treatment in which a portion of the liver is removed from a healthy person and transplanted to a patient with end-stage hepatobiliary disease, which has only emerged since the 1990s. The advantages of living partial liver transplantation are, first of all, the effective solution of the donor source problem. It also has the advantages of good donor quality; low immune rejection if there is a blood relationship (relative donor); adequate preoperative preparation, high success rate and good prognosis; and low cost, only 1/2-1/3 of the cost of conventional liver transplantation.
The liver can compensate for hyperplasia in a relatively short period of time after resection, and a healthy person can sustain life and normal life with 1/3-1/4 of the liver. For example, clinically patients often need to have 2/3-3/4 of their liver removed due to their condition and still recover and live and work normally without any problems. The weight of the liver needed should be 1% of the patient’s body weight, e.g. an adult patient weighing 65 kg would need 650 grams of liver. The weight of a normal adult liver is 1200-1500 grams, so a normal person can save a patient’s life by removing part of his or her liver without risking his or her own life.
Living partial liver transplantation consists of two parts: donor surgery and recipient surgery.
Donor surgery: Take the left hemicolectomy as an example, the operation is as follows.
1.Take a “herringbone” incision under the rib cage to enter the abdomen and perform lobectomy.
2. Intraoperative ultrasound Doppler was used to examine the course of the middle hepatic vein to determine the resection line.
3.The gallbladder was resected, and the bile ducts were angiographed to check for biliary malformations and biliary tree distribution.
4.The first hepatic hilar was dissected, and the bile duct, hepatic artery and left branch of portal vein were freed respectively.
5.Dissect the second hepatic hilar and free the left and middle hepatic veins.
6.Separate the liver parenchyma along the marked resection line. At this point, ultrasonic knife (CUSA) can be applied to reduce bleeding. In case of larger ducts, they should be ligated or sutured.
7.Perform in situ perfusion of the donor liver, cut off the first and second hepatic hilum at the same time, cut out the left half of the liver, weigh it and immediately move it into the prepared “backstage” for trimming.
8.Close all duct stumps and perform cholangiography to check for biliary fistula.
9.Place abdominal drainage, close the abdomen, and end the donor surgery.
Recipient surgery: including two parts of diseased liver resection and new liver implantation.
1.Take a herringbone incision into the abdomen, and again determine whether there are any contraindications.
2. In addition to the conventional dissection of the first and second hepatic hilum, the dissection of the third hepatic hilum should be performed. Due to long-term cirrhosis, the diseased liver and surrounding tissues are mostly in rich collateral circulation in most patients, and great care should be taken when removing the diseased liver to reduce bleeding.
3.After resection of the diseased liver, trauma hemostasis is performed and the hepatic vein of the recipient is trimmed for anastomosis.
4.Implantation of new liver: firstly, end-to-end continuous anastomosis between donor hepatic vein and recipient hepatic vein is performed.
5.Then perform end-to-end portal vein anastomosis. After the anastomosis is completed, the liver blood flow can be opened, and the shorter the liver-free period, the better, which requires the physician to have skilled operation technique.
6.Under the microscope, perform end-to-end hepatic artery anastomosis, because the left hepatic artery is generally thin, about 1.5-2mm, in order to ensure the success of the anastomosis, generally magnify 8-10 times under the microscope anastomosis.
7.Biliary reconstruction, there are two methods of bile duct end-to-end anastomosis and bile-intestinal anastomosis depending on the situation.
8.Flush the abdominal cavity, place drainage, and close the abdomen. At the end of surgery, send the patient to the monitoring ward.
Postoperative management: close monitoring of vital signs, attention to the stability of the internal environment, strengthening of caloric supplementation; routine use of anticoagulants, anticoagulation therapy for two weeks; the use of immunosuppressive drugs; to prevent rejection reactions, the general use of diphtheria or triplet drug therapy, our hospital for hormone + cyclosporine A (or FK506) diphtheria, the effect is better. Blood concentration should be monitored frequently to adjust the dose of drugs, and once the rejection reaction occurs, the drugs or treatment plan should also be adjusted.
Anti-infection treatment: Prevention and treatment of bacterial, viral, fungal and other infections is an important part of postoperative treatment, and daily inspection of vascular patency with ultrasound Doppler for 1-2 weeks after surgery is essential to prevent complications.