肝移植治疗晚期肝泡状棘球蚴病临床研究

目的探讨原位肝移植治疗晚期肝泡状棘球蚴病(HAE)的策略和方法。方法回顾性分析新疆医科大学第一附属医院2000年12月～2009年5月实施的6例晚期HAE患者原位肝移植的临床资料。移植前和移植后均给予口服阿苯达唑脂质体(15～20mg·kg-1·d-1)抗包虫治疗。结果 6例移植手术历时中位时间635.0min(490～760min),无肝期中位时间65.5min(44～90min),术中输注红细胞悬液中位数20.5u(9～40u)。除1例抢救性经典原位肝移植因严重的肝性脑病、肾功能衰竭和凝血功能障碍而于术后第1天死亡,余5例手术成功。术后随访时间中位数6.0个月(3～19个月)。3例患者分别于术后154d、98d和6个月因胆道铸型、胆源性脓毒血症和急性排斥反应而死亡。1例活体肝移植受者术后8个月因胆道狭窄行胆肠吻合术而治愈。另1例左肺有转移灶的患者病情稳定而未发现新发病灶。结论肝移植治疗晚期HAE术前应严格掌握手术适应证和手术时机,手术难点在于病灶的清除和肝后下腔静脉的重建,移植前后抗包虫药物和低剂量免疫抑制剂的使用是预防移植后泡状棘球蚴病复发和转移的重要手段。

Experience of liver transplantation for advanced alveolar echinococcosis

Objective To summarize the clinical experience of liver transplantation （LT） for the treatment of advanced hepatic alveolar echinococcosis （ HAE） . Methods Six patients with advanced HAE underwent LT in the First Affiliated Hospital,Xinjiang Medical University from December 2000 to May 2009 were retrospectively analyzed. Preoperative and postoperative therapy with liposome albendazole （ L-ABZ, 15-20 mg·kg^-1·d^-1） was used to prevent patients from the recurrence of HAE. Results The overall medium time of the 6 LT procedures and unhepatic phrases were 635. 0 min （ range,490-760 min） and 65. 5 min （ range,44-90 min） ,respectively. The medium transfusion requirement was 20. 5 u （ range, 9-40 u） . Five LT were successfully performed for HAE except for one emergent LT case died of severe hepatic encephalopathy,renal failure and coagulation disorders on day 1 post-LT. The mean follow-up was 9 months （ range,3-19 months） . Three recipients died of incurable infection of biliary tract on day 154 post-LT,septicopyemia on day 98 post-LT,and acute rejection 6 months post-LT,respectively. The recurrence or spread of alveolar echinococcosis larvae in the other 2 cases was not observed although there was a parasitic metastatic lesion in the left lung of the 6th patient 11 months post-LT. The 4th recipient received choledochojejunostomy 8 months after living-LT because of anastomotic obstruction of biliary tract. Conclusion LT is the optimal method of treating advanced HAE. Strict compliance with the LT indications,systemic administration of L-ABZ,and a minimum dose of immunosuppressive agent are necessary to prevent from the recurrence of alveolar echinococcosis and ensure a long-term survival.