提高原位肝移植术后长期生存率临床研究

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分析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变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,肠道霉菌感染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。结论术中技术的改进及新技术的应用;采用个体化的免疫抑制方案;加强术后感染预防与治疗;加强乙肝复发的预防和治疗;预防肿瘤复发的系统措施,是提高肝移植术后生存率的关键。

Promoting the long time surrival rate in patients with Ortfaotopic Liver Transplantation

Object To Investigate promoting the survival rate in patients of orthotopic liver transplantation (OLT) . Methods Seventy two patients who underwent OLT during recent three year were collected and analyzed retrospectively. Results OLT was performed on 50 cases with benign diseases including terminal liver cirrhosis 34; 22 cases with malignant diseases including hepato cellular carcinoma 19 cases. 54 complications were occurred postoperatively, including secondary abodominal cavity bleeding (4 cases), severe infection of ascites (2 case), stress gastrio ulcer with bleeding and perforation (1 case), biliary fistula (6 case) , pulmonary infection (21 cases) , and enteric fungal infection (5 cases) There were no primary dysfunction of liver and vessal complications. Follow up 2 - 41 months, without biliary complications and chronic liver dysfunction occurred. 6 cases death postoperative, 6 cases died on follow- up period. Total survival rate is 83.33%, 32 cases alive more than 1 year, the longest survival case is 41 months postoperative. Conclusions It is suggested thatthe new techniques used in operation, individualized immunosuppression therapy, prevention of HBV reinvection after transplan, and the measures to prevent the recurrence of liver cancer are the key points for raising survival rate in OLT.