再次肝移植手术临床病例分析:附六例

目的 探讨影响再次肝移植预后的因素及再次移植手术问题.方法 回顾性总结2000年7月至2006年4月北京大学第三医院完成的6例再次肝移植病例临床资料,分析再次肝移植的原因、手术方法及病人转归.结果 6例再次肝移植的原因中:移植肝肝癌复发1例,乙型肝炎复发1例,慢性排斥反应2例,肝动脉血栓形成1例,药物性肝损害1例;再次肝移植时间距第一次肝移植平均(12.9±10.0)个月;术中出血平均(14 050±8 215)m1;平均手术时间(12.7±2.0)h.围手术期死亡3例.结论 再次肝移植病人术前一般情况差,手术风险大,正确把握手术时机及手术适应证,术中精细操作,减少出血,手术后采取个体化免疫抑制剂治疗方案等是提高再次肝移植病人存活率的关键因素.

A clinical report of 6 cases of liver retransplantation

Objective To explore the factors influencing the Results of liver retransplantation and key points for the operation. Methods The clinical data of 6 patients who received liver retrans-plantation during July 2000 to April 2006 in our hospital were retrospectively analyzed. The reasons for liver retransplantation, different Method of operation and the result of liver retransplantation were also analyzed. Results The contribution of 6 liver retransplantations were: 1 case of the recurrence of liver carcinoma, 1 of the recurrence hepatitis, 2 of chronic rejection, 1 of hepatic artery thrombosis and 1 of FK506 injury of liver. Mean time between first and second transplantation was about 12.9 months. The average blood loss was about 14 050 ml. There were 3 deaths occurred per-operation.Conclusion Liver retransplantation is at high risk for the patients whose condition maybe bad before operation. It is very important to select correct patients and time for retransplantation. The key points to get high survival include accurate procedure, minimal hemorrhage during operation and individual immunosuppressive therapy.