近40年来,胰腺移植在基础和临床研究方面都获得了令人振奋的长足进步。据国际胰腺移植登记中心(IPTR)记录,全球已实施了18 900余例胰腺移植(截至2002年10月),其中绝大多数在美国(近14 000例),约90%为胰肾联合移植(SPK)。迄今为止,SPK被公认是治疗糖尿病合并肾功能衰竭的最有效的方法。据报道,胰腺移植受体1年生存率超过95%,3年生存率接近90%; 移植胰腺有功能(患者不依赖胰岛素)者的1年和3年生存率分别为83%和77%。
胰腺移植主要包括单独胰腺移植(pancreas transplantation alone, PTA)、肾移植后胰腺移植(pancreas after kidney transplantation, PAK)和胰肾联合移植(simultaneous pancreaskidney transplantation, SPK)。与其它实体大器官移植一样,胰腺移植成功的真正转折始于20世纪70年代末。随着新型免疫抑制剂的开发和应用、器官保存技术的改进和外科技术的日臻成熟,胰腺移植在全球范围内得到迅猛开展,胰腺移植受体及器官存活率显著提高。据国际胰腺移植登记中心(International Pancreas Transplant Registry, IPTR)记录,至2001年10月,全球已实施17 000余例胰腺移植,其中美国有11 500余例,胰腺移植后患者1年生存率超过95%,3年生存率接近90%; 移植胰腺1年和3年有功能生存率分别为83%和77%[1,2]。自1966年首例SPK在美国Minnesota大学成功实施以来,SPK已成为治疗Ⅰ型糖尿病合并肾功能衰竭的常规方法,全世界迄今为止已实施的胰腺移植中约90%采用该术式[3,4]。
中国的肝脏移植事业在过去10年中取得不菲成绩,在21世纪依然保持蓬勃发展的势头。作为目前治疗肝脏终末期疾病的唯一有效手段,肝脏移植围手术期死亡率已降至5%以下,受体术后1年生存率已超过80%。然而,与国际水准相比,在术后并发症防治方面尚未形成系统化的认识,有待进一步总结经验,从而提高受体生存率和生活质量。其中血管并发症是一个常见和不应忽视的问题。尽管目前外科技术和器官保存技术屡经改良,血管并发症的发生率仍超过10%,尤其是活体部分和劈裂式肝脏移植的血管并发症发生率仍居高不下,其中具有较高死亡率的肝动脉并发症的存在尤为突出,应引起移植外科医师的足够重视并采取有效对策。
Minimally invasive surgery played a crucial role in modern medicine. With advantages such as less trauma, precise operation, minimal bleeding, and rapid postoperative recovery, minimally invasive procedures had been increasingly applied in the field of liver transplantation in recent years. This included techniques such as small incision living donor hepatectomy through an upper abdominal midline incision, laparoscopic-assisted living donor hepatectomy, pure laparoscopic living donor hepatectomy, and robotic living donor hepatectomy. Since Professor Cherqui from France firstly reported the total laparoscopic left lateral sectionectomy in living donors in 2002, the application of minimally invasive technology in living donor liver transplantation had become increasingly widespread. Based on this, so as to guide the more standardized, effective, and safe implementation of minimally invasive liver donor hepatectomy across the country, in August 2023, the Branch of Organ Transplant of Chinese Medical Association and the Branch of Organ Transplant Physicians of Chinese Medical Doctor Association organized national liver transplantation experts to jointly formulate the “Chinese guidelines for minimally invasive surgical techniques in living donor liver transplantation (2024 edition)”. This is to provide scientific guidance and reference for surgeons performing minimally invasive surgery on living liver donors in China.