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活体肝移植治疗终末期肝病 总被引:1,自引:0,他引:1
目的 探讨活体肝移植(1iving donor liver transplantation,LDLT)供、受者术前评估和手术方式的选择.方法 回顾性分析1995年1月至2007年10月我中心95例LDLT患者的临床资料.良性终末期肝病92例,其中Wilson病45例;肝脏恶性肿瘤3例.结果 供肝切取不带肝中静脉右半肝31例,带肝中静脉右半肝3例,带肝中静脉左半肝51例,不带肝中静脉左半肝或左外叶10例.所有供者术后顺利恢复,均未出现严重并发症.受者随访1~86个月,良性终末期肝病受者1、3、5年累积生存率分别为89%(82例)、78%(71例)和73%(67例),其中Wilson病受者1、3、5年累积生存率分别为92%(42例)、89%(40例)和76%(34例).3例肝脏恶性肿瘤患者死亡2例,1例长期生存.供、受者铜代谢均恢复正常.结论 建立供者安全保障体系是LDLT开展的先决条件,选择合理的手术方式是提高受者生存率的关键.亲体肝移植是治疗Wilson病的有效手段. 相似文献
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肝移植是治疗终末期肝病的有效治疗手段,为解决供体严重短缺的问题,在活体肝移植方面发展了新的手术技术,边缘供体已被用于活体肝移植以扩大供体库. 相似文献
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肝移植是治疗终末期肝病的有效治疗手段,为解决供体严重短缺的问题,在活体肝移植方面发展了新的手术技术,边缘供体已被用于活体肝移植以扩大供体库. 相似文献
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原位肝移植治疗终末期肝病9例初步报告 总被引:3,自引:1,他引:3
1993年9月至1996年7月分别为9例终末期肝病病人施行了原位肝移植术。其中4例为原发性肝脏恶性肿瘤,5例为良性终末期肝病。移植术式除1例背肽式肝移植和1例减体积肝移植外,其余7例均为原位全肝移植,并为1例多囊肝,多囊肾,合并肝,肾功能损害闰人施行了肝,肾联合移植术。 相似文献
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目的 评价肝移植治疗终末期自身免疫性肝病的疗效并总结临床经验.方法 回顾性分析2003年9月至2009年7月间因终末期自身免疫性肝病接受肝移植手术的11例患者的临床资料,其中8例为原发性胆汁性肝硬化,2例为自身免疫性肝炎,1例为原发性硬化性胆管炎.平均年龄为(44.2±8.7)岁.手术方式均采用附加腔静脉整形的改良背驮式肝移植术.术后免疫抑制治疗采用他克莫司或环孢素A联合激素的二联免疫抑制方案,部分患者使用骁悉和熊去氧胆酸.结果 本组11例患者中2例原发性胆汁性肝硬化患者死亡,其中1例于术后第5天死于肺部感染和多器官功能衰竭,另1例于术后964 d死于脓毒症和移植肝失功.5例患者术后1个月内出现急性排斥反应,加强免疫抑制治疗后痊愈.9例患者生存良好并存活至今,随访期7~62个月,中位随访时间为38个月.受体1年存活率为91%,3年存活率为82%,最长存活期5年.随访期间未发现复发病例.结论 肝移植是治疗终末期自身免疫性肝病的惟一有效手段,手术时机的正确把握和有效的免疫抑制治疗是减少肝移植术后并发症的关键.Abstract: Objective To evaluate the effect of liver transplantation for end-stage autoimmune liver disease (ESALD) and summarize the clinical experience of liver transplantation in the treatment of ESALD.Methods The clinical data of 11 ESALD cases who underwent liver transplantation from September 2003 to July 2009 were analyzed retrospectively. There were 2 males and 9 females ( median age, 44. 2 ± 8. 7years). The indication of liver transplantation was end stage of primary biliary cirrhrosis (8 cases),autoimmune hepatitis (2 cases), and primary sclerosing cholangitis ( 1 case). In all cases, modified piggyback liver transplantation with venacavaplasty was carried out. Postoperatively all patients were treated with immunosuppressive agents including tacrolimus (or cyclosporine A) and prednisone, some patients were treated additionally with mycophenolate mofetil and ursodeoxycholic acid. Results Postoperatively 2patients of primary biliary cirrhosis died, one of lung infection and multiple organ failure on the 5th postoperative day, the other dying of sepsis and graft dysfunction on the 964th postoperative day. Five cases suffered from episodes of acute cellular rejection within 1 month after transplantation and was successfully reversed by strengthened immunosuppressive therapy. Nine patients recovered satisfactorily and with excellent life quality until now. Patients were followed up from 7 months to 62 months with the median follow-up time of 38 months. The recipient survival rate at 1 year and 3 years was 91% and 82% ,respectively. One patient has now survived for 5 years. No recurrent ALD case was found during follow up.Conclusions Orthotopic liver transplantation is an exclusive treatment for ESALD. Optimum operation timing and effective immunosuppressive treatment are very important for decreasing occurrence of complications. 相似文献
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目的 总结分析肝移植中门静脉血栓(PVT)的处理经验以及PVT对肝移植术后疗效的影响.方法 总结1995年5月至2007年9月194例接受肝移植手术的患者的临床资料,其中术前存在PVT 24例(12.4%),Ⅰ级12例、Ⅱ级9例、Ⅲ级2例、Ⅳ级1例.根据血栓程度分级采取不同的方式进行门静脉重建.术后根据凝血酶原时间(PT),应用普通肝素或低分子肝素预防性抗凝.术后应用多普勒超声监测门静脉血供.选取同期接受肝移植手术的无PVT的170例患者作为对照组,比较两组手术过程和预后的差别.结果 21例Ⅰ级、Ⅱ级血栓患者行血栓切除术,2例Ⅲ级血栓患者行髂静脉-肠系膜上静脉搭桥,1例Ⅳ级血栓患者将供肝门静脉和受者粗大的门静脉属支吻合.有PVT组比无PVT组手术时间和住院时间长,输血量多,术后PVT的再发率高(P<0.05),但并发症发生率、围手术期病死率和术后1年生存率两组间无差别(P>0.05).PVT组有2例术后血栓再发,经放射介入治疗治愈.结论 术前PVT的存在增加了肝移植手术的难度和术后PVT的再发率,但对肝移植的预后没有影响. 相似文献
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终末期肝病行肝移植治疗的适应证选择 总被引:1,自引:0,他引:1
终末期肝病一般指经内外科无法治愈的各种急性、慢性、先天性和代谢性肝病。自1963年3月1日美国Starzl首例原位肝移植(orthotopic liver transplantation, OLT)问世以来,经过近40年的发展,其手术死亡率已降至10%以下,移植年成活率超过80%,5年成活率可达75%,术后生活质量大大改善。OLT已成为治疗终末期肝病最确切又根本的治疗手段。我院自1977年首例OLT以来,累计病例数超过150例,目前正以每年超过50例的速度发展,术后一年生存率(良性终末期肝病)达… 相似文献
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5例终末期酒精性肝硬变病人在香港大学玛丽医院肝胆外科施行原位肝移植手术。男4例,女1例。年龄41~55岁,平均468岁。病人均经心理医学医生评估适合作肝移植,并且在肝移植前至少戒酒6个月。供肝全部来自脑干死亡病人。供肝灌注和保存应用UW液。4例肝移植术中应用静脉转流技术,1例采用Piggyback法。术后应用类固醇、硫唑嘌呤和环胞霉素A作免疫抑制治疗。移植肝脏和患者的存活率均为100%,并已分别生存6月~3年,情况良好。肝移植可使末期酒精性肝硬变病人延长生命和恢复正常生活。 相似文献
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Pascal Perney Michaël Bismuth Hélène Sigaud Marie Christine Picot Eric Jacquet Pierre Puche Samir Jaber Hélène Rigole Françis Navarro Jean-Jacques Eledjam François Blanc Dominique Larrey Georges-Philippe Pageaux 《Transplant international》2005,18(11):1292-1297
Predictive factors for alcoholic relapse after liver transplantation (LT) performed for alcoholic liver disease (ALD) have been assessed in numerous studies, often with contradictory results. The aim of the study was to assess pretransplantation alcohol consumption characteristics on alcoholic relapse after LT. Patients transplanted for ALD for at least 6 months were included. An anonymous questionnaire assessed socio-demographic characteristics, medical history, and alcohol consumption before and after LT. Relapse was defined as any alcohol use after LT. Severe relapse was defined by heavy drinking: more than 21 units/week for males and 14 units/week for females. A total of 61 patients were studied. The mean follow up after LT was 49 +/- 34 months. Alcoholic relapse occurred in 32 of 61 patients (52%) and severe relapse in eight of 61 patients (13%). Risk factors for severe relapse were: length of abstinence before LT (P = 0.0001), more than one alcohol withdrawal before LT (P = 0.001), alcohol dependence (P = 0.05), alcohol abuse in first relatives (P = 0.05), and younger age (P = 0.05). Information on previous alcohol consumption (dependence, number of withdrawals, family history) helps to predict severe relapse after LT in patients with ALD, allowing early awareness and specific postoperative care. 相似文献
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Alcoholic liver disease is one of the most common causes of cirrhosis and indications for orthotopic liver transplantation in Europe and North America. The reluctance to transplant alcoholics stems in part from the view that alcoholics bear responsibility for their illness. There is also the perception that the alcoholic person is likely to relapse into alcohol use after transplantation and thereby damage the allograft. In this review, we considered the evaluation for and outcome of liver transplantation in alcoholics with special attention to the specific risks of alcohol relapse, to show that alcoholism should be considered like other co-morbid states rather than as a moral flaw. 相似文献
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M. Pera Juan C. García-Valdecasas Luis Grande Antoni Rimola Josep Fuster Antonio M. Lacy Andres Cifuentes Isabel Cirera Miquel Navasa Josep Visa 《Transplant international》1997,10(4):289-292
The results of orthotopic liver transplantation (OLT) in patients with alcoholic liver cirrhosis (ALC) are currently similar
to those obtained in patients with other indications. However, the frequent association of ALC with hepatitis C virus (HCV)
infection may impair these results. We retrospectively studied the consequences of HCV infection on survival and graft function
in 59 patients with ALC undergoing OLT. Patients were classified into two groups depending on their HCV serology before transplantation:
group 1 comprised 24 anti-HCV-positive patients, and group 2, 35 anti-HCV-negative patients. Patient and graft survival were
similar in both groups. Liver function tests 1 and 4 years after OLT showed AST and ALT values that were significantly higher
in group 1 patients and post-transplant histologically proven chronic hepatitis was found in 45 % and 61 % of these patients
at 1 and 4 years, respectively. We conclude that pretransplant HCV infection in patients with ALC does not affect survival
after OLT. However, one must bear in mind the high incidence of post-transplant chronic hepatitis secondary to recurrence
of HCV infection and be cautious when drawing this conclusion.
Received: 1 October 1996 Received after revision: 3 March 1997 Accepted: 17 March 1997 相似文献
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Steven Masson Benjamin Marrow Stuart Kendrick Ahmed M. Elsharkawy Sandra Latimer Mark Hudson 《Transplant international》2014,27(5):475-481
Return to drinking after liver transplantation for alcoholic liver disease (ALD) remains a source of unease with varying reported rates of return to drinking and impact this has on graft function. In 2005, the UK Transplant liver advisory group recommended an ‘alcohol contract’ in which ALD patients listed for transplantation confirmed in writing their commitment to abstinence. We aimed to measure the rates and consequences of return to drinking alcohol in a UK transplant programme and assess the effect of the ‘alcohol contract’. Consecutive patients transplanted for ALD during 1996–2011 were included. Every patient listed after Feb 2007 signed up to the ‘alcohol contract’. We compared rates and pattern of return to drinking and survival before and after the introduction of the contract. Overall, 52 (37%) patients returned to drinking alcohol; 37 (39%) before and 15 (34%) after the contract. There was no significant difference in the rate of return or pattern of drinking. Median survival was 176 months (145–207 95% CI). There was no significant difference in survival, mortality rates, or in the causes of death in either group. We report high rates of return to drinking alcohol in a UK liver transplant programme. Despite this, the impact on patient and graft survival is low. There is no evidence that an ‘alcohol contract’ has had any effect on alcohol consumption. 相似文献
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目的 为了进一步总结和探讨良性终末期肝病行肝移植手术时机的合理选择和提高肝移植成功率。方法 回顾性分析了20例良性终末期肝病行肝移植手术的病人对手术时机的掌握以及术后出现的各种并发症。结果 本组病人UNOS分级:I级4例,2例出现颅内出血,1例出现严重的肺部感染致多器官功能衰竭;Ⅱ级15例,1例出现颅内出血,1例出现急性肾衰,1例出现门静脉血栓形成,1例术后表现为肝上下腔狭窄,4例出现肺部感染;Ⅲ级1例,术后恢复良好。结论 良性终末期肝病病人应合理选择肝移植手术时机,才能提高肝移植成功率。 相似文献
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Nathan JD Rudolph JA Kocoshis SA Alonso MH Ryckman FC Tiao GM 《Journal of pediatric surgery》2007,42(1):143-147