肝肾联合移植15例报道

目的探讨肝肾联合移植的适应证和疗效。方法对2001年2月至2003年12月施行肝肾联合移植术的15例患者进行了随访。15例中,乙型肝炎后肝硬化合并肝肾综合征8例、合并尿毒症2例、合并糖尿病肾病1例;多囊肝和多囊肾2例;Caroli病合并多囊肾1例;酒精性肝硬化合并尿毒症1例。对肝肾联合移植患者的手术方式,围手术期并发症,术后急、慢性排斥反应和乙型肝炎复发情况及随访结果进行了分析。结果15例肝肾联合移植术后移植物功能均恢复良好,6个月和1年生存率为100%。1例术前有严重营养不良者,术后给与48d的呼吸机支持后康复。术后创面出血和消化道出血各1例,经非手术治疗后治愈。胆道吻合口狭窄1例,用内镜下球囊扩张术治愈。1例术后2周发生急性移植肝排斥反应,给予激素冲击治疗后得到控制。1例术后30个月时因停用拉米夫定后乙型肝炎复发死于移植肝功能丧失。结论肝肾联合移植是终末期肝病合并慢性肾功能衰竭或肾功能损害的安全有效方法。对乙型肝炎患者术后尽早应用拉米夫定和乙型肝炎病毒免疫球蛋白预防肝炎复发。     

原位肝移植术后近期并发症的防治

目的：探讨原位肝移植术后并发症发生的常见原因、预防及处理措施。方法：回顾性分析我科近3年来所施行的72例原位肝移植病人术后并发症发生的种类及数量，以及诊治处理方法。结果：72例肝移植病人中，原发病为良性疾病50例（其中终末期乙肝肝硬变34例），恶性疾病22例（其中HCC19例）。术后发生并发症54例次，因凝血功能紊乱致术后腹腔内继发性出血4例，术前腹水感染未能控制致术后腹水严重感染2例，激素用量过大致应激性溃疡出血、穿孔1例，胆漏6例，肺部感染21例，肠道霉菌感染5例。全组无原发性肝无功能及血管并发症，随访2-41个月。无远期胆道并发症及慢排发生。住院期死亡6例，随访期死亡6例，目前生存60例，总生存率为80.33％，存活超过1年者32例，最长已3年5个月。结论：我国肝移植病人适应证以终末期乙肝肝硬化为主，这类病人肝功能不良，凝血障碍，围手术期凝血功能的纠正甚为重要，同时这类病人多存在营养不良，免疫功能低下，应重视围手术期感染的控制及营养支持。手术技术的完善是预防肝移植后血管并发症的关键。     

肝脏移植受体手术与外科相关并发症防治

目的总结防治肝移植受体手术后外科相关并发症的方法与经验。方法回顾性分析2000年1月-2006年12月32例行肝移植患者临床资料,其中肝豆状核变性3例,慢性重症肝炎3例,晚期肝硬化12例（其中淤胆性肝硬化2例）,原发性肝癌合并肝硬化12例,肝门部胆管癌合并肝硬化2例。结果所有手术均获成功,术中平均出血量3 600（1 000-10 000）ml,手术时间平均5.2（4-9）h。围手术期死亡3例,分别死于术后出血、急性肾衰和移植肝无功能。术后腹腔出血4例,胆漏4例,胆管狭窄2例,无血管并发症。结论肝移植受体手术创伤大,术中应仔细操作,严密止血,高质量完成各种管道的重建,可大大减少各种外科相关并发症。     

Caroli's disease: liver resection and liver transplantation. Experience in 33 patients

BACKGROUND: The aim of this study was to review and discuss our observations on 33 patients who underwent surgical treatment for Caroli's disease (CD), focusing on diagnosis, current surgical management, and long-term outcome. METHODS: Between May 1993 and June 2004, 642 liver resections and 286 liver transplantations in 252 patients were performed in our department of surgery. Thirty-three patients were referred to our center for diagnostic and therapeutic management of CD. Prior surgical interventions for hepatobiliary disorders, current diagnostic and surgical procedures, procedure-specific complications, duration of hospital stay, duration of follow-up, outpatient information, and long-term outcome were reviewed. RESULTS: Fifteen male and 18 female patients were treated in this study. Initial symptoms and signs of the disease noted in our patients included right upper quadrant pain, fever, and jaundice. In 2 of the 33 patients, we noted clinical evidence of cirrhosis followed by histologic confirmation. One patient suffered from variceal bleeding. In 26 patients, diagnoses were established by a combined endoscopic retrograde cholangiopancreatography, ultrasonography, and computed tomographic studies. The disease was localized in 25 and diffuse in 8 patients. Liver resection was carried out in 29 patients. Partial hepatectomies were performed in 27 of these 29 at our institution. Two female patients with the diffuse disease underwent orthotopic liver transplantation. Thirteen of the 31 patients who underwent surgery at our institution had an uneventful postoperative course. Fourteen patients had minor postoperative complications and responded well to medical management. Four patients had major complications that required further surgical treatment. Two patients died of complications related to postoperative hemorrhage and sepsis. Two patients with intrahepatic cholangiocarcinoma died because of primary tumor progress. One patient with cholangiocarcinoma died 1 year after a successful left hepatectomy because of metastatic disease recurrence. The long-term results of the 26 surviving patients were assessed during a mean follow-up of 3.7 years (range, 1-11 years). All 26 patients remained free of biliary symptoms or complications. In 25 patients, surgery including liver transplantation was curative. CONCLUSIONS: Partial hepatectomy for localized CD is potentially curative. In patients with diffuse CD, liver transplantation provides gratifying long-term results.     

同种原位肝移植术后并发症的防治体会

目的 探讨同种原位肝移植术后并发症发生的常见原因与预防及处理。方法 回顾性分析我科近一年来所施行的18例原位肝移植病人术后并发症发生的种类及数量,以及诊治处理方法,以探讨成功及失败原因,结果 18例肝移植病人中,原发病为终末期乙肝肝硬变13例,造型性弥漫性肝内胆管囊性扩张2例,布－加氏综合征1例,原发性肝癌2例,术后发生并发症15例次,含因凝血功能紊乱致术后腹腔内继发性出血3例,术前腹水感染未能控制致术后腹水严重感染1例,激素用量过大致应激性溃疡出血、穿孔1例,胆瘘1例,肺部感染4例,口腔弥漫性溃疡3例,肠道霉菌感染2例,手术死亡3例,分别为肺部曲霉菌感染,应激性溃疡穿孔及腹水感染所致。术后5个在肝癌复发死亡1例,现仍存活14例,4例已存活1年以上。结论 我国肝移植病人适应证以终末期,乙肝肝硬化为主,这类病人肝功不良,凝血障碍,围手术期凝血功能的纠正甚为重要,同时这类病人多存在营养不良,免疫功能低下,应重视围手术期感染的控制及营养支持,手术技术的完善是预防肝移植后血管并发症的关键。     

An appraisal of pediatric liver transplantation from living relatives. Initial clinical experiences in 20 pediatric liver transplantations from living relatives as donors.

The authors performed 20 liver transplantations from living related donors between June 1990 and July 1991. The 20 pediatric patients (14 biliary atresia, two Budd-Chiari syndrome, one liver cirrhosis after hepatitis C viral infection (HCV hepatitis), 1 progressive intrahepatic cholestasis, 1 liver cirrhosis, 1 protoporphyria) were transplanted with 11 left lobes, eight left lateral segments, and one right lobe. The choice of donors was restricted to the parents of the recipients. The immunosuppressive treatment consisted of FK 506 and steroids. Seventeen recipients are alive, 15 of whom are well and at home. Two recipients, who underwent emergency transplantation, died of postoperative complications. Another recipient died of accidental asphyxia at 6 months after the transplantation. All 20 donors had uneventful postoperative courses and were able to resume their normal social lives. The arterial ketone body ratio (AKBR) increased to above 1.0 within 2 days after the transplantation in all cases. Relatively mild rejection episodes were encountered in only two cases transplanted with ABO-compatible grafts, and these were treated successfully with steroids and FK 506.     

Liver transplantation and hepatitis C

End-stage liver disease caused by chronic hepatitis C viral infection is one of the major indications for liver transplantation. However, evidence for ongoing viral replication can already be found days after surgery and may lead sequentially to lobular hepatitis, chronic active hepatitis, fibrosis and liver cirrhosis. In some patients, this evolution is remarkably fast, most probably enhanced by the immunosuppressive therapy. A minority of patients develop a clinical picture of progressive cholestatic liver disease with histological signs of chronic rejection, which may necessitate retransplantation. While the 1- and 5-year survival rates for all patients transplanted because of hepatitis C virus (HCV)-induced liver cirrhosis are satisfactory, severe complications of disease recurrence are nonetheless expected during the first and second decade after liver transplantation. Larger and preferably randomized studies are needed to investigate whether combination therapy with interferon and ribavirin, preferably initiated as soon as possible after liver transplantation, prevents the fast evolution to cirrhosis without the appearance of chronic rejection and the expected complications of recurrent end-stage HCV-induced liver disease. The final goal should be the inhibition of viral replication even before liver transplantation, but other antiviral strategies should probably be used to attain this goal in patients with decompensated cirrhosis. Although the recurrence of a hepatitis C infection and concomitant disease in the liver graft may cause substantial morbidity, end-stage liver disease and liver failure caused by a chronic hepatitis C infection remain good indications for liver transplantation.     

The impact of renal transplantation on the course of hepatitis B liver disease

To establish the impact of transplantation on the course of chronic hepatitis B liver disease we performed a prospective study of the clinical and pathological sequelae of hepatitis B disease in all 22 patients who had renal allografts that functioned for more than 1 year and who were hepatitis B surface antigen (HBsAg)-positive following transplantation. No patient converted to HBsAg-negative. During a mean follow-up of 83 months serial liver biopsies were performed in 20 patients and 1 liver biopsy was available in the remaining 2 patients. Eleven patients died of liver disease, 5 of whom died of hepatic failure, 3 with hepatoma, 2 of gastrointestinal hemorrhage, and 1 of ascites with pleuroperitoneal fistula. Aggressive liver disease was observed in the vast majority of patients: 12 ultimately developed cirrhosis, (mean follow-up 81 months), 6 chronic active hepatitis (mean follow-up 93 months), 3 chronic persistent hepatitis (mean follow-up 89 months), and in 1 patient the presence of HB virus in hepatocytes was the sole morphologic alteration (follow-up 42 months). There was a marked tendency to progression in that 82% of patients with virus only, reactive hepatitis, or chronic persistent hepatitis on initial biopsy subsequently developed chronic active hepatitis or cirrhosis. For comparison, 10 HBsAg-positive patients whose renal failure had been treated by hemodialysis were also studied over a comparable period. Four patients converted to the negative state. Biochemical evidence of persistent liver dysfunction occurred in only 1 patient and no patient has died from complications of liver disease. We conclude that in the immunosuppressed renal transplant patient HB infection often results in the development of cirrhosis, leading to death from hepatoma and hepatic failure. This course is worse than that in dialysis patients. Renal transplantation of HBsAg-positive patients with end-stage renal failure may be inadvisable.     

Living-donor liver transplantation: results of a single center

In the absence of cadaveric donor liver transplantation, living-donor liver transplantation (LDLT) is an alternative option for patients with end-stage liver disease. The objective of this study was to evaluate the outcome of LDLT at a single medical center in Turkey. We retrospectively analyzed the results of 101 LDLTs in 99 recipients with end-stage liver disease. We transplanted 49 right liver lobes, 16 left lobes, and 36 hepatic segments II and III. Most donors (46%) were parents of the recipients. Seventeen recipients had concomitant hepatocellular carcinoma and cirrhosis. Retransplantation was performed in two recipients. Ten hepatic arterial thromboses, 1 hepatic arterial bleeding, and 12 biliary leaks occurred in the early postoperative period. Most complications were treated with interventional techniques. Three hepatic vein stenoses, three portal vein stenoses, one hepatic arterial stenosis, and six biliary stenoses developed during the late postoperative period. Recipients with those complications were treated with interventional techniques. Mean follow-up was 14.2 +/- 10.9 months. During that time, no tumor recurrence was detected in any recipient with hepatocellular carcinoma. Twenty-two recipients died during the follow-up. At this time, the remaining 77 recipients (77%) are alive, exhibiting good graft function. In general, complication rates are slightly higher after LDLT than after cadaveric liver transplantation. However, most complications can be treated with interventional techniques. LDLT continues to be a life-saving option in countries without satisfactory cadaveric donation rates.     

提高原位肝移植术后长期生存率的临床研究

目的 探讨提高原位肝移植术后长期生存率的临床措施。方法 回顾性分析我科3年多来所施行的72例原位肝移植病人术后生存情况、并发症发生的种类及数量，以及诊治处理方法，以探讨成功及失败原因。结果 72例肝移植病人中，原发病为良性疾病50例(其中终末期乙肝肝硬化34例)；恶性疾病22例(其中HCC19例)。术后发生并发症54例次，含因凝血功能紊乱致术后腹腔内继发性出血4例，术前腹水感染未能控制，致术后腹水严重感染2例，激素用量过大致应激性溃疡出血、穿孔1例，胆瘘6例，肺部感染21例，肠道真菌感染5例。全组无原发性肝无功能及血管并发症，随访2～41个月，无远期胆道并发症及慢排发生。住院期死亡6例，随访期死亡6例，目前生存60例，总生存率为83．33％，存活超过1年者32例，最长已3年5个月。结论 ①术中技术的改进及新技术的应用；②采用个体化的免疫抑制方案；③加强术后感染预防与治疗；④加强乙肝复发的预防和治疗；⑤预防肿瘤复发的系列措施，是提高肝移植术后生存率的关键。     

Pediatric liver transplantation: the Montreal experience

The introduction of cyclosporine A in 1980 greatly improved the survival of children with end-stage liver disease undergoing orthotopic liver transplantation. The average 1-year survival rate following hepatic transplantation increased from 30% in 1963 to 70% in 1980. This report summarizes the initial experience of two pediatric hospitals in Montreal--H?pital Ste-Justine and Montreal Children's Hospital. Since December 1985, 13 orthotopic liver transplantations have been performed in 11 patients: six females and five males. The median age was 18 months (range, 13 months to 17 years) and the median weight was 10 kg (range, 8.5 to 38 kg). The indications for transplantation were biliary atresia (5 patients), tyrosinemia (2 patients), biliary hypoplasia (1 patient), Amerindian cirrhosis (1 patient), Crigler-Najjar syndrome, type I (1 patient), and fulminant non-A, non-B hepatitis with grade IV encephalopathy (1 patient). Immunosuppression was ensured by cyclosporine A, azathioprine, and steroids. The function of 11 grafts was immediate following revascularization of the grafts. One graft had delayed function due to preservation injury, and one had primary nonfunction. Surgical complications included bile peritonitis (1), ruptured aneurysm of an aortic conduit (1), and thrombosis of the hepatic artery necessitating retransplantation (2). Three of our patients died, one from postoperative cerebral edema, one of primary nonfunction of the graft, and one of ruptured aneurysm of an aortic conduit. Our overall survival rate was 72% with a follow-up of 3 to 32 months. Pediatric liver transplantation can now provide successful treatment and cure of liver diseases considered, until recently, dismal and hopeless.     

肝移植手术出血特点及其对术后呼吸功能恢复的影响

目的研究肝移植手术中出血特点以及失血/输血量对术后呼吸功能恢复的影响。方法回顾性分析我科于2001年月2～2006年月948例几种不同病因肝移植患者手术过程出血特点以及失血、输血量对呼吸功能恢复的影响。结果病肝切除阶段是主要的出血时间段,广泛渗血为主要特点;不同疾病病因手术出血量明显不同。出血量最多为肝癌合并肝硬化、其它依次为肝硬化、急性重症肝炎、无肝硬化肝癌(P<0.05)。术中出血量大于5000ml明显影响患者术后呼吸功能的恢复,并且造成较高的围手术期并发症及死亡率(P<0.05)。结论肝移植术中大出血与术后呼吸功能恢复和术后并发症关系密切,是影响肝移植成败的重发因素之一。因此,尽量减少手术中出血是非常重要的。     

Liver Transplantation for Cystic Fibrosis in Adults

Purpose To expand our knowledge on liver transplantation for cirrhosis associated with cystic fibrosis in adults. Methods Five patients who underwent a liver transplantation due to cystic fibrosis were reviewed. The outcome of the patients in terms of age, immunosuppression regimen, patient and graft survival, and pre- and post-transplant complications were investigated. Results Five adult liver transplant patients had cystic fibrosis (0.2%). These included 4 men and 1 woman with a mean age of 31 ± 10, ranging from 22 to 52 years old at the time of transplantation. All patients had lung problems. Four patients had exocrine and two had endocrine pancreatic insufficiency. Two are currently alive with a follow-up of 5.8 years and 4 months after transplantation, respectively. There were three deaths from pulmonary embolism at 4.5 years, myocardial infarction with cyclosporine nephrotoxicity at 10.7 years, and lymphoproliferative disorder at 5 months after transplantation. No deaths occurred from lung infection. Only one patient had postoperative pulmonary infectious complications, which were successfully treated with antibiotics and did not result in mortality. Conclusion Adult liver transplantation for end-stage liver disease associated with cystic fibrosis offers encouraging results with a rapid general improvement after surgery and it is now considered to be a safe and acceptable treatment for this disease population.     

Acute renal failure in the first 100 orthotopic liver transplant patients in Southern Iran

Postoperative acute renal failure is a frequent and serious medical complication following orthotopic liver transplant. Here, we report our experiences with liver transplant recipients who developed acute renal failure in the early period following orthotopic liver transplant. Among 100 liver transplants performed between April 1993 and January 2004, we retrospectively analyzed 91 patients (mean age, 29.9 +/- 14.0 years) who had undergone orthotopic liver transplant. The underlying causes of liver failure were cryptogenic liver cirrhosis (n=27), viral hepatitis (n= 21) (hepatitis-B-related liver cirrhosis [n=13], hepatitis-C-related liver cirrhosis [n=7], and hepatitis-B- and C-related liver cirrhosis [n=1]), autoimmune hepatitis (n=18), Wilson's disease (n=10), primary sclerosing cholangitis (n=8), biliary atresia (n=3), Budd-Chiari syndrome (n=2), and primary biliary cirrhosis (n=2). The immunosuppressive regimen included mycophenolate mofetil (azathioprine for 10 patients), cyclosporine, and steroids. Six patients received a combination of tacrolimus and steroids. Ten patients (10.9%) experienced acute renal failure, 7 (70%) were men, and none of them required renal replacement therapy and/or died. Four patients were diagnosed as having cryptogenic liver cirrhosis; 2 with hepatitis-C-related liver cirrhosis, 2 with autoimmune liver cirrhosis; 1 with primary biliary cirrhosis; and 1 hepatitis-B-related liver cirrhosis. Six patients were Child-Pugh's classification C, and the others were B. The rate of postoperative acute renal failure in our patients was relatively low when compared with other series, and our outcomes were good.     

Liver transplantation for HCV cirrhosis at Karolinska University Hospital Huddinge, Stockholm

Hepatitis C virus (HCV)-induced cirrhosis is the major indication for liver transplantation globally, and an increasing indication for liver transplantation in Sweden. We have retrospectively examined the 120 patients transplanted for HCV cirrhosis from 1987 through 2005, including 11 who received more than one graft. The 1-, 3-, and 5-year postoperative survivals for all patients transplanted for HCV with or without hepatocellular cancer (HCC) were 77%, 66%, and 53%, respectively. HCV patients without HCC had a 1-, 3-, and 5-year survivals of 78%, 73%, and 61%, compared with 84%, 79% and 74%, respectively, for patients transplanted with chronic liver diseases without cancer or HCV. The number of patients with HCV cirrhosis transplanted in our center is increasing. Compared with patients transplanted for other chronic liver diseases, we experienced inferior results among patients with HCV cirrhosis.     

成人原位背驮式肝移植--附8例报告

目的 研究原位背驮式肝移植治疗终末期肝病的手术技巧及临床效果。方法 在23月内为8例终末期肝病病人实施原位肝移植手术,其中肝炎后肝硬化2例,肝癌1例,酒精性硬化1例,化疗后中毒性肝炎致肝硬化1例,原发件胆汁性肝硬化3例。结果 手术成功率100％,1例手术后32天死于肾功能衰竭,围手术期存活7例（87.5％）,随访期间7例病人均存活,现存活7例（87.5％）,生存时间最长1例已23个月。术后并发症:腹腔出血并肾衰竭1例;腹腔内出血胆瘘致腹膜炎1例。结论 肝移植手术是终末期肝病的有效治疗手段。在成人原位背驮式肝移植病肝切除术中,有效的预防减少出血及其它手术并发症,预防肝移植术后乙肝再感染,有效而合理的使用免疫抑制剂是提高手术成功率,保证长期生存的关键。     

Surgical complications accompanying liver transplantation in Estonia

The purpose of this study was to evaluate surgical complications accompanying the introduction of orthotopic liver transplantation (OLT) in Estonia. Between 1999 and 2009, we performed the first 12 liver transplantations. Eight patients were males and four were females of age range 12 to 67 years. Their diagnoses were cholestatic disease (n = 5); tumor (n = 3); hepatitis C virus cirrhosis (n = 2); Budd-Chiari syndrome (n = 1); and cystic fibrosis (n = 1). Technical complications occurred in 7/12 patients. The early vascular complications in two patients were a suprahepatic vena cava lesion occurring at liver extraction, which resulted in uncontrolled suprahepatic bleeding after liver perfusion; the recipient died during transplantation. The other case displayed a right intrahepatic portal venous thrombosis, which was treated successfully with thrombolysis and anticoagulant therapy. Early biliary complications of biliary leaks occurred in three patients: two had undergone duct-to-duct reconstructions, which were treated by endoscopic retrograde cholangiography that successfully managed the anastomotic and recipient cystic duct leaks with a papillotomy and stenting. In one patient with a duct-to-jejunum anastomosis, a bile leak stopped at 3 weeks but he needed surgical therapy 2 years later due to an anastomotic stricture. Severe decubitus occurred in the lumbosacral region of the subjects with operating times of 14 hours. They required necretectomy and plastic surgery. One of them with postoperative intra-abdominal hypertension also displayed wound eventration requiring reoperations. The rate of hepatic (5/12) and extrahepatic (3/12) surgical complications, as well as of 1-year survival (9/12), in our period of implementation of OLT were satisfactory to continue OLT development in Estonia.     

Current indication of a modified Sugiura procedure in the management of variceal bleeding

BACKGROUND: The role of gastroesophageal devascularization (Sugiura-rype procedures) for the treatment of variceal bleeding remains controversial. Although Japanese series reported favorable longterm results, the technique has nor been widely accepted in the Western Hemisphere because of a high postoperative morbidity and mortality. The reasons for the different outcomes are unclear. In a multidisciplinary team approach we developed a therapeutic algorithm for patients with recurrent variceal bleeding. STUDY DESIGN: The Sugiura procedure was offered only to patients with well-preserved liver function (Child A or Child B cirrhosis without chronic ascites) who were not candidates for distal splenorenal shunt, transhepatic porto-systemic shunt, or liver transplantation. RESULTS: Fifteen patients with recurrent variceal bleeding underwent a modified Sugiura procedure between September 1994 and September 1997. All but one patient (operative mortality 7%) are alive after a median followup of 4 years. Recurrent variceal bleeding developed in one patient; esophageal strictures, which were successfully treated by endoscopic dilatation, developed in three patients; and one patient experienced mild encephalopathy. Major complications were noted only in patients with impaired liver function (Child B cirrhosis) or when the modified Sugiura was performed in an emergency setting. The presence of cirrhosis or the cause of portal hypertension had no significant impact on the complication rate. CONCLUSIONS: This series was performed during the last decade when all modern therapeutic options for variceal bleeding were available. Our results indicate that the modified Sugiura procedure is an effective rescue therapy in patients who are not candidates for selective shunts, transhepatic porto-systemic shunt, or transplantation. Emergency settings and decreased liver function are associated with an increased morbidity.     

成人活体肝移植的早期经验

目的 总结成人活体肝移植的早期经验,提高活体肝移植效果.方法 回顾性分析解放军总医院肝移植中心2006年6月至2008年2月31例成人活体肝移植资料.结果 31例中慢性乙型肝炎肝硬化失代偿期8例,急性肝功能衰竭7例,肝细胞肝癌12例,肝脏紫癜病2例,肝门部胆管癌1例和Wilson 病1例.含肝中静脉(middle hepatic vein,MHV)的右半肝移植25例,不含MHV的右半肝移植3例,双供肝为含MHV的右半肝+左外叶和含MHV的右半肝+左半肝各1例,左半肝辅助性原位肝移植1例.33例供者中5例发生并发症6例次.9例受者发生并发症11例次,其中胆道并发症4例,血管并发症3例,感染性并发症3例,切口延迟愈合1例.2例肺部感染和1例全身多处曲霉菌感染者死亡.结论 活体肝移植已成为拓展供肝来源的有效途径,合理的供、受者评估,手术方式和术后处理是关键.     

七例八次背驮式原位肝移植

对４例Ｗｉｌｓｏｎ病及３例晚期肝病患者施行了８次背驮式原位肝移植术，其中１例为减体积性背驮式原位肝移植。３例已分别存活２年、９个月、６个月，４例死于术后并发症。认为代谢性疾病是原位肝移植的最佳适应证，其次是肝硬变；术后感染、急性和慢性排斥、肺部并发症及胆道并发症是影响患者存活的重要因素；背驮式原位肝移植对全身血流动力学的影响较小。