腹腔镜供肝获取手术的发展与展望

doi:10.16139/j.1007-9610.2024.02.05

摘要/Abstract

摘要：

近年来，得益于微创外科技术的进步，腹腔镜供肝获取手术(LLDH)得到了迅速的发展。从2002年该项技术首次报道以来，各大移植中心一直在不断探索发展和积累经验。相比于传统的开放手术，该项技术有着创伤小、术中出血少、术后并发症发生率低等优点。但同时，在热缺血时间管理、克服学习曲线、避免胆道并发症以及出血控制等方面存在着一定的难点，仍需更多的探索以解决这些问题。一些新技术和新方法的应用也使该项技术更加安全、高效。本文从LLDH的发展历程、手术难点和并发症、技术改进等三个方面进行讨论，并展望该项技术的未来前景和发展方向。

关键词: 腹腔镜供肝获取, 活体肝移植, 热缺血时间, 胆道并发症

Abstract:

In recent years, benifit by the advancement of minimally invasive surgical techniques, laparoscopic living donor hepatectomy（LLDH） has experienced rapid development. Since this technology was first reported in 2002, major transplant centers have been continuously developing and accumulating experience. Compared with traditional open surgery, LLDH has advantages such as less trauma, less intraoperative bleeding, and lower incidence of postoperative complications. However, at the same time, there were certain difficulties in managing, such as, warm ischemia time, overcoming learning curves, avoiding biliary complications, and controlling bleeding, still needed to be solved. The application of some new technologies and surgical methods also made this technology more efficient and safer. This article discussed the development history, surgical difficulties and complications, and technical improvements of LLDH, and looked forward to the future prospects and development directions of this technology.

Key words: Laparoscopic living donor hepatectomy(LLDH), Living donor liver transplantation, Warm ischemia time, Biliary complication

中图分类号:

R657.3

李书乐, 陆录. 腹腔镜供肝获取手术的发展与展望[J]. 外科理论与实践, 2024, 29(02): 121-125.

LI Shule, LU Lu. Development and prospect of laparoscopic living donor hepatectomy[J]. Journal of Surgery Concepts & Practice, 2024, 29(02): 121-125.

参考文献 39

[1]	RELA M, REDDY M S. Living donor liver transplant (LDLT) is the way forward in Asia[J]. Hepatol Int, 2017, 11(2):148-151. doi: 10.1007/s12072-016-9780-z pmid: 28097531
[2]	RAIA S, NERY J R, MIES S. Liver transplantation from live donors[J]. Lancet, 1989, 2(8661):497. pmid: 2570198
[3]	HUMAR A, GANESH S, JORGENSEN D, et al. adult living donor versus deceased donor liver transplant (LDLT versus DDLT) at a single center: time to change our paradigm for liver transplant[J]. Ann Surg, 2019, 270(3):444-451.
[4]	KIM W J, KIM K H, CHO H D, et al. Long-term safety and efficacy of pure laparoscopic donor hepatectomy in pediatric living donor liver transplantation[J]. Liver Transpl, 2021, 27(4):513-524.
[5]	SOUBRANE O, DE ROUGEMONT O, KIM K H, et al. Laparoscopic living donor left lateral sectionectomy: a new standard practice for donor hepatectomy[J]. Ann Surg, 2015, 262(5):757-761; discussion 761-763.
[6]	MARUBASHI S, NAGANO H. Laparoscopic living-donor hepatectomy: review of its current status[J]. Ann Gastroenterol Surg, 2021, 5(4):484-493. doi: 10.1002/ags3.12450 pmid: 34337297
[7]	CHERQUI D, SOUBRANE O, HUSSON E, et al. Laparoscopic living donor hepatectomy for liver transplantation in children[J]. Lancet, 2002, 359(9304):392-396. doi: 10.1016/S0140-6736(02)07598-0 pmid: 11844509
[8]	KIM K H, JUNG D H, PARK K M, et al. Comparison of open and laparoscopic live donor left lateral sectionectomy[J]. Br J Surg, 2011, 98(9):1302-1308. doi: 10.1002/bjs.7601 pmid: 21717424
[9]	KOFFRON A J, KUNG R, BAKER T, et al. Laparoscopic-assisted right lobe donor hepatectomy[J]. Am J Transplant, 2006, 6(10):2522-2525. doi: 10.1111/j.1600-6143.2006.01498.x pmid: 16889605
[10]	GIULIANOTTI P C, TZVETANOV I, JEON H, et al. Robot-assisted right lobe donor hepatectomy[J]. Transpl Int, 2012, 25(1):e5-e9.
[11]	SAMSTEIN B, CHERQUI D, ROTELLAR F, et al. Totally laparoscopic full left hepatectomy for living donor liver transplantation in adolescents and adults[J]. Am J Transplant, 2013, 13(9):2462-2466. doi: 10.1111/ajt.12360 pmid: 24034709
[12]	ROTELLAR F, PARDO F, BENITO A, et al. Totally laparoscopic right-lobe hepatectomy for adult living donor liver transplantation: useful strategies to enhance safety[J]. Am J Transplant, 2013, 13(12):3269-3273. doi: 10.1111/ajt.12471 pmid: 24266975
[13]	SUH K S, HONG S K, LEE K W, et al. Pure laparoscopic living donor hepatectomy: focus on 55 donors undergoing right hepatectomy[J]. Am J Transplant, 2018, 18(2):434-443. doi: 10.1111/ajt.14455 pmid: 28787763
[14]	LU L, WANG Z X, ZHU W W, et al. Left hepatic vein preferential approach based on anatomy is safe and feasible for laparoscopic living donor left lateral sectionectomy[J]. Liver Transpl, 2021, 27(1):88-95.
[15]	TOTSUKA E, FUNG J J, HAKAMADA K, et al. Synergistic effect of cold and warm ischemia time on postoperative graft function and outcome in human liver transplantation[J]. Transplant Proc, 2004, 36(7):1955-1958.
[16]	CAUCHY F, SCHWARZ L, SCATTON O, et al. Laparoscopic liver resection for living donation: where do we stand?[J]. World J Gastroenterol, 2014, 20(42):15590-15598.
[17]	HONG S K, LEE K W, CHOI Y, et al. Initial experience with purely laparoscopic living-donor right hepatectomy[J]. Br J Surg, 2018, 105(6):751-759. doi: 10.1002/bjs.10777 pmid: 29579333
[18]	BROWN K M, GELLER D A. What is the learning curve for laparoscopic major hepatectomy?[J]. J Gastrointest Surg, 2016, 20(5):1065-1071. doi: 10.1007/s11605-016-3100-8 pmid: 26956007
[19]	DOGEAS E, TOHME S, GELLER D A. Laparoscopic liver resection: global diffusion and learning curve[J]. Ann Acad Med Singap, 2021, 50(10):736-738. doi: 10.47102/annals-acadmedsg.2021371 pmid: 34755166
[20]	SULTANA A, NIGHTINGALE P, MARUDANAYAGAM R, et al. Evaluating the learning curve for laparoscopic liver resection: a comparative study between standard and learning curve CUSUM[J]. HPB (Oxford), 2019, 21(11):1505-1512.
[21]	BUELL J F, CHERQUI D, GELLER D A, et al. The international position on laparoscopic liver surgery: the louisville statement, 2008[J]. Ann Surg, 2009, 250(5):825-830. doi: 10.1097/sla.0b013e3181b3b2d8 pmid: 19916210
[22]	KOBAYASHI S, HONDA G, KURATA M, et al. An experimental study on the relationship among airway pressure, pneumoperitoneum pressure, and central venous pressure in pure laparoscopic hepatectomy[J]. Ann Surg, 2016, 263(6):1159-1163. doi: 10.1097/SLA.0000000000001482 pmid: 26595124
[23]	YUAN Y, GOTOH M. Biliary complications in living liver donors[J]. Surg Today, 2010, 40(5):411-417. doi: 10.1007/s00595-009-4143-1 pmid: 20425542
[24]	PARK J, KWON D C H, CHOI G S, et al. Safety and risk factors of pure laparoscopic living donor right hepatectomy: comparison to open technique in propensity score-matched analysis[J]. Transplantation, 2019, 103(10):e308-e316.
[25]	RHU J, CHOI G S, KIM J M, et al. Intraoperative ultrasonography as a guidance for dividing bile duct during laparoscopic living donor hepatectomy[J]. Ann Transplant, 2019,24:115-122.
[26]	SHIN M, SONG S, KIM J M, et al. Donor morbidity including biliary complications in living-donor liver transplantation: single-center analysis of 827 cases[J]. Transplantation, 2012, 93(9):942-948.
[27]	CAUCHY F, FUKS D, NOMI T, et al. Risk factors and consequences of conversion in laparoscopic major liver resection[J]. Br J Surg, 2015, 102(7):785-795. doi: 10.1002/bjs.9806 pmid: 25846843
[28]	SILVA J P, BERGER N G, YIN Z, et al. Minimally invasive hepatectomy conversions: an analysis of risk factors and outcomes[J]. HPB (Oxford), 2018, 20(2):132-139.
[29]	QU Z, WU K J, FENG J W, et al. Treatment of hepatic venous system hemorrhage and carbon dioxide gas embolization during laparoscopic hepatectomy via hepatic vein approach[J]. Front Oncol, 2023,12:1060823.
[30]	PARK J B, JOH J W, KIM S J, et al. Effect of intermittent hepatic inflow occlusion with the Pringle maneuver during donor hepatectomy in adult living donor liver transplantation with right hemiliver grafts: a prospective, randomized controlled study[J]. Liver Transpl, 2012, 18(1):129-137.
[31]	WAKABAYASHI G, CHERQUI D, GELLER D A, et al. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka[J]. Ann Surg, 2015, 261(4):619-629. doi: 10.1097/SLA.0000000000001184 pmid: 25742461
[32]	SAKKA S G. Assessment of liver perfusion and function by indocyanine green in the perioperative setting and in critically ill patients[J]. J Clin Monit Comput, 2018, 32(5):787-796. doi: 10.1007/s10877-017-0073-4 pmid: 29039062
[33]	WANG X, TEH C S C, ISHIZAWA T, et al. Consensus guidelines for the use of fluorescence imaging in hepatobiliary surgery[J]. Ann Surg, 2021, 274(1):97-106. doi: 10.1097/SLA.0000000000004718 pmid: 33351457
[34]	MIZUNO S, ISAJI S. Indocyanine green (ICG) fluorescence imaging-guided cholangiography for donor hepatectomy in living donor liver transplantation[J]. Am J Transplant, 2010, 10(12):2725-2726. doi: 10.1111/j.1600-6143.2010.03288.x pmid: 21062417
[35]	COUBEAU L, FREZIN J, DEHON R, et al. Indocyanine green fluoroscopy and liver transplantation: a new technique for the intraoperative assessment of bile duct vascularization[J]. Hepatobiliary Pancreat Dis Int, 2017, 16(4):440-442.
[36]	DOUSSE D, VIBERT E, NICOLAS Q, et al. Indocyanine green fluorescence imaging to predict graft survival after orthotopic liver transplantation: a pilot study[J]. Liver Transpl, 2020, 26(10):1263-1274.
[37]	MENG X, WANG H, XU Y, et al. Indocyanine green fluorescence image-guided total laparoscopic living donor right hepatectomy: the first case report from Mainland China[J]. Int J Surg Case Rep, 2018,53:406-409.
[38]	李宏宇, 魏林, 朱志军, 等. 吲哚菁绿荧光引导腹腔镜解剖性肝段获取术在小儿活体肝移植中的应用价值[J]. 中华消化外科杂志, 2021,(1):118-124.
	LI H Y, WEI L, ZHU Z J, et al. The application value of indocyanine green fluorescence guided laparoscopic anatomical liver segment acquisition in pediatric living liver transplantation[J]. Chin J Dig Surg, 2021,(1):118-124.
[39]	LU L, ZHU W W, SHEN C H, et al. The application of real-time indocyanine green fluorescence cholangiography in laparoscopic living donor left lateral sectionectomy[J]. HepatoBiliary Surg Nutr,Publish Ahead of Print, 2024.