自 1963 年至 20 世纪 80 年代末，肝移植 术式较为单一，各医院及移植中心主要采用经 典 原 位 肝 移 植 (Standard Orthotopic Liver Transplantation)。1984 年之前，经典术式中不
使用转流泵，之后才开始使用。20 世纪 80 年 代末至 90 年代，肝移植术式有了较大的创新， 背驮式肝移植 (piggyback liver transplantation, PBLT)以其手术时间、手术技术方面的优势，迅 速成为最常用的肝移植术式之一。而肝移植手 术的适应 证逐步扩大，肝源则日益紧张，移植 学家们为肝源地有效利 用及新肝源的开拓也尝 试开展了多种新移植术式：劈离式肝移植 (split liver transplantation, SLT)能够实现将一个供肝 分配给两个人使用；而活体肝移植、自体肝移 植、多米诺肝移植则扩大了供肝来源；肝细胞 移植因基础性问题尚未解决，而异种肝移植则
Supported by: National Science and Technology Support Planning Project of China, No. 2008BAI60B01*
Received:2011-06-23 Accepted:2011-08-03
中国医学科学院 医学信息研究所， 北京市 100020
郭柯磊，孙晓北，李 扬，池 慧
Conventional and new surgical approaches to liver transplantation
Guo Ke-lei, Sun Xiao-bei, Li Yang, Chi Hui
Abstract BACKGROUND: Liver transplantation is an important method in the treatment of the end-stage liver dise ases and hepatic carcinoma, but nowadays the donors are more and more decreased, which are the choke point of the liver transplantation. The development of the surgery approaches of the liver transplantation can support to utilize the grafts and broaden the donors effectively. OBJECTIVE: To provide references for the clinicians to carry out liver transplantation and study the approaches through reviewing the developments and characteristics of conventional and new surgical approaches in liver transplantation. METHODS: Pubmed database, CNKI database and some liver transplantation registries were retrieved for the relate literatures of surgery approaches published between January 1900 and January 2011. Then, 35 literatures of clinical studies, reviews and reports were analyzed. RESULTS AND CONCLUSION: Totally 1 251 articles were obtained in initial retrieval, of which 35 articles were chosen to be analyzed based on the inclusion criteria. Standard orthotopic liver transplantation and Piggyback liver transplantation were conventional, and new approaches were emerging. Split liver transplantation could be realized for providing a graft to two recipients. Living donor liver transplantation could be used flexibly and developed rapidly. Liver autotransplantation wasvery difficult in the techniques, so it was rarely used. Domino liver transplantation could be used to treat FAP effectively, but it was also rarely used due to difficulties in the technology. Hepatocytes transplantation and liver xenotransplantation were not sufficiently studied. Conventional surgical technologies have been well mastered because of the advantages in utilizing the grafts and extending the source of grafts. New approaches have broad application prospects, but need the breakthroughs in surgical techniques and basic research.
中国组织工程研究与临床康复 第 15 卷 第 53 期 2011–12–31 出版 Journal of Clinical Rehabilitative Tissue Engineering Research December 31, 2011 Vol.15, No.53
常规及新肝移植手术的现状*★
Correspondence to: Chi Hui, Researcher, Master’s supervisor, Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China Chi.hui@imicams. .

郭柯磊，等. 常规及新肝移植手术的现状
因术后免疫排斥未有效控制，尚处于研究阶段，但为进 一步扩大肝源的提供了新途径。
文章在国内外肝移植临床文献及综述的基础上，综 述了目前的常规术式以及新的移植术式的发展及特点， 旨在为肝移植的开展与术式研究提供参考。
1 资料和方法
1.1 资 料 来 源 由 第 一 作 者 在 2011－ 02 检 索 了 Pubmed 、 中 国 期 刊 全 文 数 据 库 以 及 各 肝 移 植 注 册 系 统。其中，在 Pubmed 中检索的时间范围为 1900－ 01/ 2011－01；在 CNKI 中检索的时间范围为：2001－ 01/ 2010－01。 英 文 检 索 词 为 ：“ Liver Transplantation/ methods”[Mesh] ；“ Liver Transplantation/ utilization” [Mesh]；限定词为“Clinical Trial， Editorial，Practice Guideline，Review”；中文检索词为 “肝移植，术式， 经典原位肝移植，背驮式肝移植，活体肝移植，劈离式 肝移植，多米诺肝移植，肝细胞移植，异种肝移植，进 展 ， 现 状 ”。 1.2 入选标准
郭柯磊★，男， 1986 年生，河南 省洛阳市人，汉 族，中国医学科学 院/北京协和医学 院医学信息研究 所在读硕士。 Guokelei049@
通讯作者：池慧， 研究员，硕士生导 师，中国医学科学 院/ 北京协和医学 院医学信息研究 所，北京市 100020 Chi.hui@
郭柯磊，孙晓北，李扬，池慧. 常规及新肝移植手术的现状[J].中国组织工程研究与临床康复，2011，15(53): 10047-10051. [ ]
0 引言
自 1963－03－ 01 美国的 Starzl 教授实施首 例人体原位肝移植以来，肝移植技术的不断进 步，目前肝移植已经是公认的治疗良性终末期 肝病和肝癌的一个重要手段。在这一过程中， 肝移植术式从单一到多样化，不断发展了起来。
Guo KL, Sun XB, Li Y, Chi H. Conventional and new surgical approaches to liver transplantation.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu. 2011;15(53): 10047-10051ical Information/Medical Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China
Guo Ke-lei★, Studying for master’s degree, Institute of Medical Information/ Medical Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China Guokelei049@163. com