95例肝移植临床分析

目的：结合目前国内临床肝移植的现状,进一步总结近年内肝移植的临床经验。方法：分三个阶段回顾性分析了95例原位肝移植的临床资料。其中1993年-1997年为第一阶段,1999年为第二阶段,2000年1月-2002年3月为第三阶段。分析三个阶段中原发疾病构成、手术技术、术后管理及术后并发症治疗等问题。结果：第一、二阶段受体原发病以肝脏恶性病变为主（53％-100％）,第三阶段则以良性病变居多（65％）;术后早期良恶性病变患者的生存率差异无显著性,但以后肝细胞性肝癌患者则多于肿瘤的复发与转移;第三阶段良性病变1年的生存率为85％,总手术死亡率为5％;第三阶段无静脉转流技术的开展已显示出其优越性;乙肝病毒再感染率一年为24％;血管并发症逐渐减少;胆道并发症仍是后期的主要问题。结论：受体的严格筛选、手术技术的完善与提高、术后近远期并发症的及时合理诊治及原发疾病复发防治是命名国内肝移植上一新台阶的必备条件。

Clinical analysis of different periods of liver transplantation at an organ transplantation centre

OBJECTIVE: To summarize our clinical experience in liver transplantation while considering the background in this field in China. METHODS: Ninety-five patients who had received liver transplantation from April 1993 to March 2002 were analyzed retrospectively. Three periods were defined objectively as period I (1993 - 1997), II (1999) and III (2000 - 2002). Operative techniques, recipients, original diseases, complications and survival rates were compared among the three periods. RESULTS: Malignant liver lesions were the main cause for liver transplantation in period I and II. The ratio of number of malignant disease to total recipients decreased gradually from period I to III (100%, 53% and 35%, respectively). The 1-year survival rate in patients with benign liver disease was 85% and the total operative mortality was 5% in period III. The incidence of hepatitis B virus reactivation or reinfection was 24% twelve months after liver transplantation. Vascular complication decreased but biliary complications did not and remained a major long-standing problem. No veno-venous bypass technique was used in period III, and its advantages were obvious when comparing with those with veno-venous bypass in period I and II. CONCLUSIONS: Strict selection of recipients, fine operative technique, familiarity with various complications and correct therapeutic methods, prophylaxis of recurrence of hepatitis B and hepatocellular carcinoma are necessary to improve long-term results of liver transplantation in China.