再次肝移植治疗移植肝缺血型胆道损伤15例报告

目的探讨再次肝移植治疗缺血型胆道损伤的临床经验。方法回顾性分析15例因缺血型胆道损伤施行再次肝移植受者的临床资料。结果 15例移植受者术前均接受过介入治疗,再次肝移植全组无手术死亡。术后1个月存活率为67%,1年存活率为60%,3年存活率为53%。截止至2012年3月,有8例存活并返院随诊,存活时间超过5年的5例,其余3例存活时间分别为47个月、58个月、35个月,肝功能及生活情况良好。术后严重感染导致的多器官功能衰竭是再次肝移植患者死亡的主要原因。结论再次肝移植是治疗缺血型胆道损伤唯一有效的方法。对于缺血性胆道损伤,预防的意义远大于治疗。从供肝切取与保存、胆道重建、术后免疫抑制方案的选择、长期随访等等环节加以重视,有利于减少缺血型胆道损伤。

Retransplantation for ischemic type biliary lesion of the first transplanted live graft:15 cases report

Objective To investigate clinical experience of liver retransplantation for the treatment of ischemic type biliary lesion(ITBL).Methods Clinical data of 15 retransplantation recipients for ITBL were retrospectively analyzed.Results All of the 15 recipients underwent interventional therapies before retransplantation.No perioperative death occurred during retransplantation.The survival rate was 67% at 1 month,60% at 1 year and 53% at 3 years after operation respectively.Eight patients were survived and followed up in hospital until March 2012.Five cases survived for more than 5 years and other three cases survived for 47,58 and 35 months respectively with good liver function and life quality.Severe infection and multi organ dysfunction after operation were the primary causes of death in retransplantation patients.Conclusions Retransplantation is the only effective treatment for ITBL.Prevention is much more important than treatment.Paying more attention to liver procurement and preservation,biliary tract reconstruction,optimum immunosuppression and long-term follow-up etc will decrease the incidence of ITBL.