器官移植2026，Vol.17Issue(5)：765-771,7.DOI:10.12464/j.issn.1674-7445.2026077
Laennec膜间隙在再次肝移植中应用的临床研究
Clinical study on the application of Laennec membrane space in repeated liver transplantation
摘要
Abstract
Objective To explore the application value of Laennec's membrane space in dealing with complex anatomical variations and dense adhesions during repeated liver transplantation(Re-LT).Methods The clinical data of 8 cases of Re-LT recipients treated in the Department of Hepatobiliary Surgery of the First Hospital Affiliated to Harbin Medical University were retrospectively analyzed.During the operation,based on the Laennec's membrane anatomical concept,the remaining Laennec space and the free technique within the hepatic portal plate were flexibly applied for dissection.Specifically,the first hepatic portal main ducts(biliary and portal veins)were dissected by lowering the hepatic portal plate inside the Laennec's membrane space,and the second hepatic portal was exposed to perform the modified piggyback liver transplantation to avoid the injury to the right adrenal gland and right kidney caused by the free inferior vena cava below the liver.Moreover,the dense adhesions between the liver and hollow organs were separated by a combination of blunt and sharp dissection within the subcapsular space of the liver capsule(Glisson capsule).Results All 8 cases of recipients successfully completed the surgery.Among them,7 cases underwent end-to-end biliary anastomosis with a T-tube left in place,and 1 underwent choledochoenteric anastomosis,2 cases underwent modified piggyback reconstruction,2 cases used the subcapsular dissection technique to handle organ adhesions.One recipient died of generalized drug-resistant Klebsiella pneumoniae infection combined with septic shock after the operation,while the remaining 7 cases were discharged after the main complications(such as delayed graft function recovery,pulmonary infection,bile leakage,etc.)were cured or significantly improved.Two cases of recipients who used the subcapsular dissection technique effectively avoided the secondary injury of hollow organs,and no digestive tract leakage complications occurred after the operation.Conclusions By flexibly applying Laennec's membrane space and the intrahepatic portal plate free technique in Re-LT,it may effectively cope with the loss of anatomical layers and vascular dense adhesions,reducing the surgical difficulty and the risk of secondary injury,providing important technical support for improving the prognosis of recipients.关键词
Laennec膜间隙/再次肝移植/肝门板/致密粘连/改良背驮式肝移植/Glisson包膜/移植物功能延迟恢复/胆道并发症Key words
Laennec's membrane space/Repeated liver transplantation/Hepatic portal plate/Dense adhesion/Modified piggyback liver transplantation/Glisson's capsule/Delayed graft function/Biliary complication分类
医药卫生引用本文复制引用
于杨,田大治,林汉,刘嘉铭,金也,陆朝阳..Laennec膜间隙在再次肝移植中应用的临床研究[J].器官移植,2026,17(5):765-771,7.基金项目
黑龙江省重点研发项目(2022ZX06C17) （2022ZX06C17）
黑龙江省自然科学基金联合基金重点项目(JJ2025ZL0023) （JJ2025ZL0023）
