70例原位肝脏移植

目的总结肝脏移植治疗不同终末期肝病的经验,探讨肝移植在治疗肝细胞癌(HCC)和重症乙型肝炎(乙肝)的疗效,以及评价拉米夫定对预防乙肝复发的价值.方法回顾性分析了自1993年4月～2000年12月实施的70例肝移植患者的临床资料.肝移植的主要指征是原发性肝癌(26例)、肝硬化(21例)、重症乙型肝炎(12例)、硬化性胆管炎(4例)以及其它终末期肝病(7例).对12例重症乙型肝炎患者应用拉米夫定治疗.采用多元回归分析确定影响肝移植预后的危险因素.结果54例患者存活1个月以上,16例患者在移植术后30d内死亡,院内存活率为77.1%,肝功能属ChildA级和B级的患者院内存活率明显高于ChildC级患者(P＜0.05),小肝癌患者的疗效优于大肝癌患者.移植前APACEⅢ评分,腹水量以及血肌酐水平与肝移植预后有密切关系.在重症乙肝患者中,9例仍存活、存活时间为2～24个月,拉米夫定可有效地预防肝移植术后乙肝复发,且无明显的副作用.结论本研究结果表明原位肝移植可使部分HCC患者获得治愈,部分病例可获得良好的姑息疗效,病例选择对肝癌肝移植的预后极其重要;结果还提示肝移植是治疗各种终末期肝病的有效手段.同时认为拉米夫定是一种疗效肯定,副作用小的预防肝移植术后乙肝病毒复发的药物.

Orthotopic liver transplantation: report of 70 cases

OBJECTIVES: To summarize the results of liver transplantation for various end-stage liver diseases at Sun Yat-sen University of Medical Sciences, define the role of liver transplantation in treatment of hepatocellular carcinoma (HCC) and fulminant hepatitis B, and assess the value of lamivudine for preventing HBV recurrence. METHODS: Clinical data of seventy patients undergoing orthotopic liver transplantation (OLT) at Sun Yat-sen University of Medical Sciences between April 1993 and December 2000 were retrospectively analyzed. The main indications for liver transplantation were HCC (26 cases), liver cirrhosis (21), fulminant hepatitis B (12), sclerosing cholangitis (4) and other terminal liver diseases (7). Lamivudine was used in 12 patients with fulminant hepatitis B. Logistic multivariate regression analysis was employed to determine the risk factors predicting outcome of liver transplantation. RESULTS: Fifty-four patients survived for more than one month and 16 patients died within 30 days after OLT. The overall hospital survival rate was 77.1%. The hospital survival rates in Child's A and B patients were 87.5% and 83.3%, respectively. They were superior to those of the Child's C patients (P < 0.05). The outcome of patients with small HCC was superior to that of patients with large HCC. Preoperative APACE III scores, the severity of ascites, and serum creatine level had an independent influence on outcome. Of the patients with fulminant HBV infection, 9 survived for 2-24 months. Treatment with lamivudine monotherapy was both well tolerated and efficacious in patients with fulminant Hepatitis B. CONCLUSIONS: OLT can cure some patients and provide palliation for others with HCC. Patient selection is extremely important for predicting outcome. The results support the application of liver transplantation as a therapeutic modality for various end-stage liver diseases. Lamivudine is effective and safe in OLT for patients with HBV infection.