肝移植分为同种异体肝移植(allotransplantation of the liver)和异种肝移植(xenotransplantation of the liver),迄今,按供肝植入位置、供肝的体积、供肝来源和供肝植入方式,同种异体肝移植的术式可分为如下几种:
1.异位肝移植(heterotopic liver transplantation):保留受体原肝,将供肝植入受体体腔的其他部位,如在脾床上、盆腔或脊柱旁部位。
2.原位肝移植(orthotopic liver transplantation):切除受体肝,将供肝植入受体原肝部位。原位肝移植又可分为以下5种(图1-1)
图1-1 肝移植分类
(1)标准式肝移植:供肝大小和受体腹腔大小相匹配,按原血管解剖将整个供肝植入受体的原肝部位。
(2)减体积性质肝移植(reduced-sized liver transplantation):在受体腹腔较小而供肝体积相对较大,受体体腔不能容纳的情况下,切除部分供肝后再原位植入。
(3)活体部分肝移植(living related donor liver transplantation):从活体上切取肝左外叶作为供肝植入受体的原肝部位。
(4)劈离式肝移植(split liver transplantation):将供肝分成两半,分别移值给两个受体。
(5)原位辅助性肝移植(orthotopic auxiliary liver transplantation):保留受体的部分肝脏,将减体积后的供肝植入病肝切除部分的位置(图1-2)。
背驮式技术(orthotopic auxiliary liver transplantation):切除病肝时,保留受体的肝后下腔静脉,将供肝上下腔静脉与受体的3条肝静脉或肝中、肝左静脉所形成的共同开口相吻合,或供、受体肝后下腔静脉行侧吻合,重建肝脏的血液流出道,结扎供肝的肝后下腔静脉。此技术不论是全肝移植或减体积性减体积性肝植均可采用,在活体部分肝移植时必须采用背驮式技术(图1-3)。
图1-2 原位辅助性肝移植
切除病肝左外叶,取供肝左外叶值入
1.病肝2.新肝3.下腔静脉4.门静脉5.肝动脉
图1-3 背驮式供肝植入技术
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