人工肝支持系统在肝移植围手术期的应用

目的探讨人工肝支持系统(Artificial liver support system,ALSS)在原位肝移植围手术期对急慢性肝功能衰竭的作用。方法回顾性分析401医院2003-09～2006-03实施肝移植40例,其中5例在肝移植围手术期进行人工肝治疗的临床资料。结果本组5例中,4例为术前人工肝血浆置换,患者的血清胆红素降低,肝性脑病得以纠正,凝血功能有改善,均顺利过渡到肝移植手术,术后已生存17～25个月,目前肝功能正常。1例为肝移植术后2个月,发生顽固性高胆红素血症并发感染,经4次人工肝治疗,延缓了肝衰竭的进程,接受了胆管造影,胆管支架置入引流,终因移植肝的功能衰竭,未能再次肝移植,术后5个月病死。结论AISS能纠正肝衰竭患者术前代谢紊乱,改善机体的内环境,为患者等待供肝,提高耐受肝移植手术创造条件,可减少手术风险。也能为术后肝功能提供有力支持,争取再次肝移植的机会。

Application of artificial liver support system in peri-operation of orthotopic liver transplantation

Objective To summarize the experience of application of artificial support system (ALSS) during perioperative period of orthotopic liver transplantation (OLT).Methods The 5 patients were selected to be received ALSS therapy from 40 patients who underwent liver transplantation from September 2003 to March 2006,their clinical data were analysed retrospectively.Results Decreased total serum bilirubin,corrected hepatic encephalopathy and asecites,and improved coagulation function was achieved in the 4 cases following received ALSS before OLT.The 4 cases had survived for 17 to 25 months after OLT,and their liver function still being normal.One patient who had received ALSS which had been operated at 4 months after OLT died from hyperbilirubinaemia and infections with transplan- tared liver function failure later 5 months after OLT.Conclusion The timely application of ALSS can provide necessary and valuable support to the patients during perioperative period of OLT.Preoperative ALSS treatment should be applied actively as an important preoperative component of OLT.Postoperative ALSS treatment can give an essential support for the secondary OLT.