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。

Promotion of long-term survival rate in patients receiving orthotopic liver transplantation

Objective To determine clinical measures for promoting long-term survival rate in patients after orthotopic liver transplantation (OLT). Methods The clinical data of 72 patients undergoing OLT in recent 3 years in our hospital were retrospectively analyzed to explore reasons for success and failure. Results Of the 72 patients, 50 were with benign diseases (terminal liver cirrhosis in 34) and 22 with malignant diseases (hepatocellular carcinoma in 19). After the operation, 54 complications including secondary abdominal cavity bleeding (4 cases), severe infection of ascites (2 cases), stress gastric ulcer with bleeding and perforation (1 case), biliary fistula (6 cases), pulmonary infection (21 cases) and fungal infection (5 cases) occurred. There were no primary dysfunction of liver and vascular complications. A follow-up study for 2-41 months showed that there were no biliary complications and chronic liver dysfunction. Six patients died during hospitalization and another 6 died during the follow-up period. The total survival rate was 83.33%. Thirty-two patients survived for over 1 year. The longest survival of 41 months was found in 1 patient. Conclusions Use of new techniques in operation, individualized immunosuppressive therapy, prevention of HBV reinfection and recurrence of liver cancer after transplantation are the key points for raising survival rate in patients after OLT.