肝移植术后肝脏局部淋巴细胞增生性疾病的诊断和治疗

目的 探讨肝移植术后肝脏局部淋巴细胞增生性疾病(LL-PTLD)的临床诊断和治疗策略.方法 回顾性分析2003年7月至2011年7月间3000余例肝移植受者中发生的6例LL-PTLD的临床资料,并通过Pubmed和万方数据库检索到6例LL-PTLD患者的相关文献报道,共对12例LL-PTLD患者的诊断及治疗经验进行总结和分析.结果 所有患者均经过病理检查确诊LL-PTLD.LL-PTLD的发生率约为0.2％ (6/3000).12例患者中,绝大部分患者给予了减量或停用免疫抑制剂和抗EB病毒治疗,其治疗反应较好;6例给予了全身化疗,其中3例死亡;4例行局部放射治疗后,肿瘤得到明显控制,患者均存活良好;3例行再次肝移植治疗,其中1例因淋巴瘤复发而死亡;1例行肝部分切除术,术后未出现淋巴瘤复发.结论 肝移植后出现无法解释的肝门部梗阻时,应高度怀疑发生LL-PTLD,病理检查是诊断LL-PTLD的金标准;应尽早调整免疫抑制剂和抗EB病毒治疗,行局部放射治疗可以获得更好的治疗效果.     

胆道数字成像技术在活体肝移植肝内胆道解剖分型及胆道切面确定中的应用

Objective To evaluate biliary digital imaging technology in determining the type of the intrahepatic bile duct anatomy and the transection plane of the duct in right lobe living donor liver transplantation(LDLT). Methods Mobile digital subtraction angiography was performed to show the intrahepatic bile duct anatomy of 66 liver transplant donor candidates. Combined with metal markers, the bile duct transection plane was defined. Comparing with the actual results, the effect of digital imaging technology in determining the intrahepatic anatomical variations and transection plane of the duct in LDLT was evaluated. Results Intrahepatic bile duct anatomical variations were showed in all donors by using digital imaging technology. type Ⅰ (classical type) was identified in45 cases (68.2%), type Ⅱ (with triple confluence, the simultaneous emptying of the right anterior segmental duct, right posterior segmental duct and left hepatic duct into the common hepatic duct) in 7 cases ( 10.6% ), type Ⅲ (no right hepatic duct stem, right posterior segmental duct draining into common hepatic duct) in 13 cases ( 19. 7% ), type Ⅳ (no right hepatic duct stem, right posterior segmental duct draining into left hepatic duct) in 1 case (1.5%), and type Ⅴ (complex variation ) in no case (0%). As a result, cases of type Ⅰ form a single anastomosis. In type Ⅱ, four cases formed double anastomoses, three cases formed single anastomosis with or without ductoplasty. In type Ⅲ, two anastomoses were formed in 9 cases, single anastomosis in 4 cases with ductoplasty. The case of type Ⅳ had double anastomoses. In all cases right lobe liver were harvested.Conclusions Biliary digital subtraction image combined with metal markers accurately defines intrahepatic bile duct anatomy and the transection plane, helping to reduce number of bile duct anastomosis, and contributes to safe graft harvesting.     

肝移植术后子宫异常出血行子宫全切一例

肝移植受者中,女性比例逐渐升高,但与之相关的妇科并发症目前国内鲜有报道.本文回顾分析我院1例肝移植术后合并子宫异常出血而实施子宫全切术的临床资料,报告如下.     

Clinical and imaging study on hepatic venous congestion of Ⅴ, Ⅷ segments in living donor liver transplantation

Objective To evaluate MSCT appearance and impaction of Ⅴ, Ⅷ segments' hepatic venous congestion ( HVC ) on hepatic functional recovery in living donor liver transplantation (LDLT).Methods In this study, 83 patients undergoing LDLT in our hospital were included, all subjects received plain and contrast MSCT examinations at early stage (within 1 month) and later stage (3 months later) after LDLT. MSCT appearance of HVC was recorded, at the same time, gutamic pyruvic transaminase ( ALT),glutamic oxalacetic transaminase (AST), total bilirubin (TB) and prothrombin time (PT) of 1 to 7 days after LDLT between congestion group and non-congestion group were recorded and compared.Results Segments Ⅴ and Ⅷ congestion was identified by after LDLT CT scanning in 20 patients (24. 10% ). Congestion volume and congestion ratio was (218. 25 ± 130. 29) cm3 and 16. 68% ±8. 81%,respectively. HVC often appear as hypoattenuation on plain CT scan and arterial phase, mixed or hyperattenuation on portal vein phase. There was no significant difference of ALT, AST, TB and PT after LDLT between congestion group and non-congestion group (P ＞ 0. 05). Conclusions MSCT is a valuable method to evaluate Ⅴ, Ⅷ segments' HVC after LDLT, most HVC has no impaction on hepatic functional recovery in LDLT patients.     

合并心脏疾病肝脏移植患者的围手术期处理

肝移植是目前治疗终末期肝病的有效手段,术前合并心脏疾病是肝移植的危险因素之一。虽然肝移植的临床技术不断成熟,但是对术前合并心脏疾病的患者进行肝脏移植仍然     

胆道镜治疗肝移植术后肝内胆管阻塞40例

目的探讨胆道镜在诊断及治疗肝移植术后肝内胆管阻塞的价值。方法回顾性分析40例肝移植术后肝内胆管阻塞患者的资料。所有病例均经T管造影证实为肝内胆管阻塞伴狭窄,经T管途径扩张窦道并行胆道镜,再于X线透视下放管支撑。结果29例疗效满意;8例得到控制;3例效果较差,接受了再次移植。结论胆道镜治疗是肝移植术后肝内胆管阻塞的有效治疗方法。     

ABO血型不合肝移植20例单中心经验

目的 总结我院开展的共20例ABO血型不符的肝移植病例,并探讨同类患者可能的治疗方案.方法 2009年1月至2011年7月,我院共实施ABO血型不符肝移植20例,其中ABO血型不相容(ABO-incompatible,ABO-Ⅰ)16例,ABO血型相容(ABO-compatible,ABO-C)4例,中位随访时间为(13.3±9.2)m.结果 除术前MELD评分外,ABO-C及ABO-Ⅰ组围手术期其他资料、术后并发症发生率及累积生存率比较差异无统计学意义.20例患者中死亡5例(ABO-C组2例,ABO-Ⅰ组3例),1年生存率75％.死亡原因为围手术期多器官衰竭2例,肝癌复发2例,脑出血1例.ABO-Ⅰ组术后发生排斥反应2例,术后远期出现胆道并发症3例,术后发生门静脉血栓3例.20例患者中,术后早期发生血肌酐升高共11例,发生率55％,其中6例术前即有血肌酐升高,此6例患者术后血肌酐升高时间均超过7d,其余7例患者血肌酐水平均在术后7d内降至正常.结论 门静脉血流复通前行脾脏切除术,应用巴利昔单抗+他克莫司+霉酚酸酯+皮质激素的四联免疫抑制方案,术后静脉应用前列地尔的治疗方案,对于有选择性的ABO血型不合肝移植患者可取得较好疗效.     

原位肝移植后并发脾动脉窃血综合征四例

原位肝移植后的脾动脉窃血综合征（SASS）可导致肝动脉血流量低，灌注不足，血栓形成、闭塞，进而出现肝功能异常，甚至移植物功能丧失。我中心在2005年共完成肝移植641例，其中有4例发生SASS，现报告如下。     

人类免疫缺陷病毒感染患者肝移植两例报告

人类免疫缺陷病毒（HIV）感染患者曾被列为实质性脏器移植的绝对禁忌证之一。自上世纪90年代中期以来，随着强效抗逆转录病毒疗（HAART）的引入，HIV感染患者病死率明显降低。世界上少数移植中心先后进行了尝试性工作，选取了部分HIV感染患者作为肝脏或肾脏移植的受者。我中心于2004年先后为2例HIV感染患者施行了原位肝移植术，现报告如下。