71例人体原位肝移植对终末期肝病的治疗

目的：探讨我国现阶段人体原位肝移植治疗终末期肝病的经验，并总结围手术期处理体会。方法：回顾性分析自1993年4月至2001年8月我院连续实施的71例人体原位肝移植病人的临床资料。结果：良性终末期肝病患者术后1年生存率达到75％，恶性肿瘤受体的生存时间与生活质量也有了较大改善，围手术期单一应用拉米夫定可以明显减少移植术后HBV再感染，术中不用静脉－静脉转流技术，可以缩短手术时间，减少术中出血和输血量，有利于患者术后恢复，术后胆道并发症的发生率为5．98％，血管并发症的发生率为8．96％。结论：原位肝移植可以成为临床上治疗终末期肝病的一项常规方法。HBV相关性肝病肝移植围手术期应常规应用拉米夫定，不用静脉－静脉转流技术的肝移植在大多数成人肝移植中是安全可行，的尽早诊断胆道和血管并发症，及时采用正确的放射介入技术处理胆道与血管并发症可取得较好疗效。

Orthotopic liver transplantation for end-stage liver diseases in 71 cases

Objective To assess the role of orthotopic liver transplantation (OLT) in the treatment of end-stage liver diseases and to discuss the experience of the operation. Methods Retrospective analysis of clinical data of 71 cases of liver transplantation was performed in our hospital from April 1993 to August 2001. Results One year survival rate of recipients with benign hepatic disease was over 75%. The survival time and life quality of malignant recipients were also improved. Lamivudine monotherapy during the operation period could reduce HBV reinfection rate. The practice of OLT without veno-venous bypass (VVB) was associated with a shorter operating time, less hemorrhape. and thus less blood transfusion during the operation compared with standard technique of OLT with routine use of VVB. The occurrence rate of biliary complications was 5.98% and vascular complication 8.96%. Conclusions OLT should become a routine therapeutic choice for end-stage liver diseases. Lamivudine is helpful to reduce HBV reinfection after OLT in HBV-related liver diseases. OLT without VVB is safe and can be performed in the majority of adult patients. The early diagnosis and timely application of interventional radiological technique are important for the treatment of biliary and vascular complications.