活体肝移植治疗重型肝炎的疗效

目的 研究活体肝移植治疗重型肝炎的疗效.方法 选取18例重型肝炎患者为重型肝炎肝移植组,30例失代偿期肝硬化(非肝癌)患者作为肝硬化肝移植组,28例因供肝短缺未行肝移植的重型肝炎患者作为重型肝炎非移植组.术中密切临测患者生命体征,凝血功能,肾功能等.术后患者均行重症监护、免疫抑制治疗、改善肝功能及凝血等,并使用拉米夫定及高价乙型肝炎免疫球蛋白预防乙型肝炎复发.比较3组患者术前情况,手术方式,术后7 d肝、肾功能和并发症,随访1、6、12个月的生存率.实验室检验指标用Wilcoxon秩和检验,率的比较用χ2检验. 结果重型肝炎肝移植组和肝硬化肝移植组患者均采用活体肝移植术,两组患者手术时间,热缺血时间、冷缺血时间和移植物与受体体质量比差异无统计学意义(P值均>0.05),但术中重型肝炎肝移植组患者出血及输血量均多于肝硬化肝移植组(t值分别为0.001和0.004,P值均<0.05).术后7 d,重型肝炎肝移植组总胆红素、ALT和AST分别为(100.5±96.4)μmol/L、(215.3±195.7)U/L和(209.8±188.6)U/L,高于肝硬化肝移植组的(53.3±31.91)μmol/L、(56.3±22.1)U/L和(51.3±13.5)U/L,差异有统计学意义(t值分别为0.017、0.021和0.004,P值均<0.05);白蛋白和肌酐差异无统计学意义(P值均>0.05).术后1、6、12个月生存率,重型肝炎肝移植组分别为88.89%,83.33%、83.33%,肝硬化肝移植组分别为96.67%、93.33%、93.33%.结论 活体肝移植术是治疗重型肝炎的有效方法之一.

Evaluation of the effect of living donor liver transplantation on the treatment of severe hepatitis

Objective To evaluate the effect of living donor liver transplantation on the treatment of severe hepatitis. Methods 18 patients with severe hepatitis received liver transplantation (transplantated severe hepatitis group), 28 patients with sever hepatitis recieved non surgical treatment (non-transplantated severe hepatitis group), and 30 patients with end stage liver cirrhosis (without cancer) received liver trans-plantation (transplantated cirrhosis group). The vital sign, blood coagulation, and renal function were moni-tored during operation. After liver transplantation, patients received immunosuppressive therapy (including tacrolimus or cyclosporine A, mycophenolat, mofetil and corticosteroids), intensive care, antiviral therapy (including lamivudine and HBIg) and other treatments (including restoration of liver function and prevention of blood coagulation). Pre-operation data, operation procedure, liver function, renal function and the opera-tion complications of three groups were compared, and survival rate at 1, 6 and 12 months after operation was followed. Results There was no significant difference in the operation time, warm ischemia time, hypother-mic ischemia time and Graft-to-recipient weight ratio between the two transplantation groups (P<0.05). The blood loss volume and blood transfusion volume in the transplantated severe hepatitis group were higher than that those in the cirrhosis transplantation group (t=0.001, 0.004 and P<0.05). The levels of TBil, ALT and AST at day 7 after operation were (100.5±96.4) μmol/L, (215.3±195.7) U/L, (209.8±188.6) U/L in the transplantated severe hepatitis group, and (53.3±31.9) μmol/L, (56.3±22.1) U/L, (51.3±13.5) U/L in the transplantated cirrhosis group (t=0.017, 0.021, 0.004, P<0.05). However, there was no significant difference in the levels of Alb and Cr between these two groups (P>0.05). Survival rate was 88.89%, 83.33% 83.33% in the transplantated severe hepatitis group, and 96.67%, 93.33% 93.33% in the transplantated cir-rhosis group at 1, 6 and 12 months after transplantation. Conslusion Living donor liver transplantation is one of effect ways for the treatment of severe hepatitis.