412 16(3), 7( 2, 1), (1, 4) ( 38 ), 2, 5, 3, 4, 5, 5 15, 9 21 :,,,, (H IV) CT,,,, 31:,,,,,,,, [ 9 ], ( IVC) [ 9, 10 ], > 5 mm,,,( > 5 mm

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1 ,24,,,,, 2, 1,1, 22,7, 2,,,,1, 1, 22, 9,10IVC, 0172% 1117%, 19< 110%, 4< 018%,,, ; ; Adult2to2adult liv ing donor liver tran splan ta tion using r ight lobe graft: report of 24 ca sesyan L 2 nan, L I B o, ZENG Yong, W EN Tian2fu, ZHAO J i2chun, WANG W en2tao, YANG J ia2yin, XU M ing2qing, MA Yu2kui, CHEN Zhe2yu, L IU J iang2w en, WU Hong. L iver Transplantation D ivision, D epartm ent of Surgery, W est China Hospital, S ichuan U niversity M edical School, Chengdu , China Abstract O bjectiveto investigate the safety and feasibility of adult2to2adult living donor liver transp lantation (A2A LDLT) using right lobe graft. M ethodsfrom January 2005 to December 2005, 24 patients, 22 males and 2 females, aged 20 53, with the underlying diseases of liver cirrhosis, hepatocellular carcinoma, and Budd2Chiari syndrome, underwent A2A LDLT using right lobe graft. During the second period, including 22 cases, modified techniques were adop ted, e. g. direct anastomosis of the right hepatic vein ( RHV ) and inferior vena cava was performed in all 22 cases, reconstruction of inferior right hepatic vein was performed on 9 cases, and reconstruction of tributaries of m iddle hepatic vein by interposing a vein graft on 10 cases so as to p rovide sufficient venous outflow. Results No sever comp lication and death was found in the donors. The graft and recip ient weight ratio was 0. 72% 1. 17%, being < 1. 0% among 19 cases and being < 0. 8% among 4 cases. During the first period one of the 2 patients suffered from stenosis at the anastomotic stoma of the right hepatic vein, and the other patient suffered from small2for2size syndrome and died. During the second period modified techniques were adop ted and no more small2for2size syndrome occurred. ConclusionW ith the modified techniques, A2A LDLT has become a relative safe p rocedure. Key wordsl iver transp lantation; Revascularization; Intraoperative syndrome 40, 10,, [ 1, 2 ], 1993Yamaoka [ 3 ], 1997Lo [ 4 ] (Adult2to2 adult living donor liver transp lantation, A2A LDLT),A2A LDLT : , [ 5, 6 ] LDLT, A2A LDLT [ 7, 8 ], LDLT 31, A2A LDLT,, 11 : 2422,2, 2053( 37),, 转载

2 412 16(3), 7( 2, 1), (1, 4) ( 38 ), 2, 5, 3, 4, 5, 5 15, 9 21 :,,,, (H IV) CT,,,, 31:,,,,,,,, [ 9 ], ( IVC) [ 9, 10 ], > 5 mm,,,( > 5 mm ),,,,,,, 4UW,,,,, 41 ( bench surgery) :4UW 2 L,,,,,,,,, ( GRWR) ( GV /SLV ) 51 : [ 7, 8 ],,,,,, IVC,,, (1),,,,, 2 Roux2Y,, 61 : [ 11 ],,,, 35 [ 8 ],2, 1 3 d, ; 1 3,,, 427 m l ( m l),455 m in ( m in) 1128 m l ( m l), 755 m in ( 565 m in 1400 m in), 115 m in70 m in, 22, 70 m in 126 m in ( 84 m in) ( GRWR ) 0172%

413 1117%, 19 < 110%, 4 < 018% ( GV /SLV ) 31174% 52123%, 20<

49,,, 2, 1 28 d, 2, ( small2for2size syndrome),27 d 22 714,,,, 3

3 %, 19 < 110%, 4 < 018% ( GV /SLV ) 31174% 52123%, 20< 50%, 4< 40%24, IVC9, ( V 5, V 8 ) IVC10, 4(2) 3a: CT,; 3b: 3CT 1 () 2a: RHV, V 5, V 8 ; 2b: IVC 2IVC 4, (3), 2, 2,, 7, 5,1, 2, 1,3, 2, 1 15, 13T, 2T, 1,, T, (12) ; 9, 3 3, 42,2 1,19,510 ;2 mm 49,,, 2, 1 28 d, 2, ( small2for2size syndrome),27 d ,,,, 3 2,, ; 1 2 d,,, ; 13 d, ; 1, 20 d; 18 d,,rouxy,21 d 11A2A LDLT, [ 12 ] :,, ;

4 414 ; CT [ 13 ], [ 14 ] 242, : (1)CT,,, ( 2), (3), 1, ( 4), ( 5), 21, [ ] GRWR 1% [ 18 ], GV /SLV 50% [ 19, 20 ],, [ 4, 9 ],, [ 21 ],,,,, [ 16, 17 ] 3 2 1,,, [ 18 ],1,,14 [ 21 ],CT,5 mm, 9, 10 12,,, 19GRWR 110% ( 4< 018%, GV /SLV20< 50%, 4< 40% ),,, IVC,, IVC,,,,IVC,,,,, IVC,,,,, 31 [ 12 ] 4 CT (3),, 2,2,, 41 [ 22 ],, LDLT [ 23, 24 ],, 1,, 2 d,,, 51A2A LDLT 10% 30% [ ] : (1),,,, ( 2), ( 3) 34, 33, 4 2 : ( 1), (2), (3),,,, 3 3( 2, 1),,, ( 4),, [ 28 ]

5 415,,, [ 26 ],,,5,,,( 5),,,Glisson,,,, (6)2 mm,,, 1 Raia S, Nery JR, M ies S1 L iver transplantation from live donors1 Lancet, 1989, 2: Strong RW, Lynch SV, Ong TH, et al1 Successful liver transp lantation from a living donor to her son1 N Engl J Med, 1990, 322: Yamaoka Y, Tanaka K, Ozawa K1 L iver transp lantation from living2 related donors1 Clin Transplant, 1993, 1: Lo CM, Fan ST, L iu CL, et al1 Adult2to2adult living donor liver transplantation using extended right lobe grafts1 Ann Surg, 1997, 226: Trotter JF, W achs M, Trouillot T, et al1evaluation of 100 patients for living donor liver transplantation1 L iver Transplant, 2000, 6: W illiam s RS, A lisa AA, Karani JB, et al. Adult2to2adult living donor liver transp lantat: UK experience1 Eur J Gastroenterol Hepatol, 2003, 15: ,, 1 21, 2002, 8: , 1 1 :, ,1 1, 2001, 81: N imura Y, Hayakawa N, Kam iya J, et al1 H ilar cholangiocarcinoma surgical anatomy and curative resection1 J Hep B il Panc Surg, 1995, 2: , 1 1 :, Dulundu E, Sugawara Y, MakuuchiM1Revolution and refinement of surgical techniques for living donor partial liver transp lantation1 YonseiMed J, 2004, 45: H iroshige S, Harada N, Shimada M1 Aculte p reoperative estimation of liver graft volumetry using three2dimensional computed tomography1 Transp lantation, 2003, 75: R inellame, A lonso E, Rao S, et al1 Bodymass index as a predictor of hepatic steatosis in living liver donors1 L iver Transp l, 2001, 7: Marcos A1 R ight lobe living donor liver transp lantation: a review1l iver Transp l, 2000, 6: Sugawara Y, Makuuchi M, Akamatsu N, et al1 Refinement of venous reconstruction using cryop reserved veins in right liver grafts1 L iver Transpl, 2004, 10: Lee SG, Park KM, Hwang S, et al1 Modified right liver graft from a living donor to p revent congestion1 Transplantation, 2002, 74: Tanaka K, Ogura Y1Small2for2size graftand small2for2size syndromein living donor liver transp lantation1 Yonsei Med J, 2004, 45: Lee SG, Hwang S, Park KM, et al1 Seventeen adult2to2adult living donor liver transp lantations using dual grafts1 Transplant Proc, 2001, 33: Suehiro T, Shimada M, Kishikawa K, et al1 Effect of intraportal infusion to imp rove small for size graft injury in living donor adult liver transplantation1transp l Int, 2005, 18: Lo CM, Fan ST, L iu CL, et al1 Increased risk for living liver donors after extended right lobectomy1 Transplant Proc, 1999, 31: Kishi Y, Sugawara Y, Kaneko J, et al1 Hepatic arterial anatomy for right liver p rocurement from living donors1 L iver Transpl, 2004, 10: ,,, 1, 2004, 84: ,,1 1, 2005, 85: ,,,112 1, 2002, 82: , 1 1, 2005, 85: ,,, , 85: Stapleton GN, H ickman R, Terblanche J1 B lood supply of the right and left hepatic ducts1b r J Surg, 1998, 85: ( : ) ( :)

分级和气管是否受侵是影响预后的独立危险因素关键词状腺肿瘤 ; 癌, 乳头状 ; 预后 Clinical outcomes of 600 papillary thyroid carcinoma patients ZHANG Zong-min,

分级和气管是否受侵是影响预后的独立危险因素关键词状腺肿瘤 ; 癌, 乳头状 ; 预后 Clinical outcomes of 600 papillary thyroid carcinoma patients ZHANG Zong-min, 移性鳞癌患者的临床资料, 比较不同治疗手段的效果 50 例患者男性 44 例, 女性 6 例, 年龄 29~73 岁, 中位年龄 52.5 岁 ; 临床分期 :N2c 占 64% (32/50),N3 占 36% (18/50) 30 例患者行双颈淋巴结清扫术 50 例患者均行放疗, 剂量为 50~66