人工肝支持系统联合肝脏移植治疗晚期重型肝炎

目的 :总结人工肝支持系统 (ALSS)联合原位肝脏移植治疗晚期重型肝炎患者的经验体会。方法 :回顾性分析本单位 1993年 4月至 2 0 0 3年 2月所实施的 14 2例原位肝脏移植患者的临床资料 ,其中 13例晚期重型肝炎 (慢性重型肝炎 12例、急性重型肝炎 1例 )患者在移植前共进行了33例次的 AL SS治疗 ,并就其疗效与常规内科治疗组、ALSS治疗组 (未施行肝脏移植 )相比较。结果 :AL SS治疗患者临床症状好转 ,肝功能、内毒素等各项实验室指标显著改善 ,能维持的中位时间为 8d(2 d～ 2 2 6 d) ;13例患者在获及合适供肝后均得以顺利实施肝脏移植 ,自首次 ALSS治疗日计算 ,该组患者等待供肝的中位时间为 11d(2 d～ 2 2 6 d) ,移植术前血清胆红素 (TB)水平显著低于患者首次 AL SS治疗前水平 (P=0 .0 2 2 ) ;本组晚期重型肝炎患者半年存活率达 6 1.5 % ,显著高于未施行 ALSS和肝脏移组 (P<0 .0 0 1)。结论 :ALSS能显著改善晚期重型肝炎患者病情 ;1次或多次的 ALSS能有效保证一定的供肝等待时间 ,发挥顺利过渡到肝脏移植的桥梁作用 ;ALSS联合肝脏移植救治晚期重型肝炎患者取得良好疗效

Artifical Liver Support System Combined with Orthotopic Liver Transplantation in the Treatment of End-stage Severe Hepatitis

Objective To report the experience of application of artificial liver support system (ALSS) combined with orthotopic liver transplantation(OLT) in the treatment of end-stage severe hepatitis.Methods:The clinical data of 13 patients with end-stage severe hepatitis receiving ALSS treatment prior to liver transplantation among 142 patients who underwent OLT consecutively between April 1993 and February 2003 were analyzed retrospectively.33 runs of ALSS were applied to 12 patients with chronic severe hepatitis and one patient with acute severe hepatitis.The 6-month survival rate was compared to those in non-ALSS-non-OLT group and non-OLT group.Results:ALSS treatment facilitated improvement of liver function,endotoximia,and the tolerance to OLT,thus provided a certain waiting time for attaining the donor liver.The 6-month survival rate reached 61.5%,significantly higher than those in control groups.Conclusions:The timely application of ALSS can provide necessary and valuable liver function support to patients with end-stage severe hepatitis,thus functioning as a bridge to liver transplantation.Preoperative ALSS combined with OLT should be considered as the most effective treatment option for patients with end-stage severe hepatitis.