亲属活体供肝儿童肝移植疗效分析

目的 总结我院10例亲属活体供肝儿童肝移植手术经验,评估其临床疗效.方法 回顾性分析2006年6月至2008年5月期间完成的10例亲属活体供肝儿童肝移植供受体手术经验及临床疗效.本组男5例,女5例.肝移植年龄6个月至14岁,体重7至42 kg.其中,Wilson'S病2例,胆道闭锁3例,严重门静脉高压症3例,重型肝炎1例和肝糖原蓄积症1例.术后8例用他克莫司(FK506)及强的松,2例用环孢素A(CsA)及强的松等抗免疫排斥.结果 10例供体均顺利出院,健康生活,无并发症发生;10例受体中除1例因门静脉血栓患儿围手术期死亡外,其余9例均痊愈出院.随访中除1例于术后5个月死于排异反应、1例术后7个月死于当地意外食物中毒外,其他7例存活至今,最长生存期24个月.术后并发症5例:门静脉血栓1例,胆道狭窄1例,腹腔淋巴漏1例,ICU监护期间严重感染2例等.结论 亲属活体供肝儿童肝移植手术技术要求高,术前仔细的供、受体选择,准确的血管影像学检查、精确的手术技术和严格的围手术期管理是亲属活体供肝儿童肝移植成功的关键.

The therapeutic effect of living-related liver transplantation for children

Objective To summarize the experience of living related liver transplantation (LR-LT) for children with end-stage liver diseases and evaluate the clinical outcomes. Methods Ten pa-tients aging from 6 months to 14 years who underwent LRLT from June 2006 to May 2008 in this hos-pital were analyzed retrospectively. Five of the patients were boys and the other 5 were girls, whosebody weight was 7 to 42 kg. In all the patients, 2 suffered Wilson's disease, 3 biliary atresia, 3 cav-ernous transformation of the portal vein, 1 fulminate hepatitis and 1 glycogen storage disease. Postop-erative anti-immune rejection drugs were used as: tacrolimus and prednisone were in 8 cases, cyclospo-rine A and prednisone in 2 cases. Results All donors recovered and were discharged without complica-tions. Nine recipients recovered and were discharged, while 1 died of portal vein thrombosis on the 4th day postoperatively. During follow-up, 1 recipient died of rejection at 5 months after discharge, anoth-er one died of unexpected food-poisoning at 8 months after discharge. Seven survived till now, the lon-gest survival period was 24 months. Post-transplantation complications included portal vein thrombo-sis, chyloperitoneumhemophagocytic syndrome and stenosis of biliary tract in each 1 case, bacterial in-fections in respiratory tract and abdominal cavity in 2 cases. Conclusions The accurate selection of do-nors and recipients, skillful surgical technique, and good per;operative intensive care are critical in suc-cessful LDLT for children.