肝肾联合移植的临床研究(附5例报告)

目的探讨肝肾联合移植的手术技术和临床处理经验.方法给5例患者(2例为肝炎后肝硬化、肝功能不全合并慢性肾功能衰竭,2例为原发性肝癌合并慢性肾功能衰竭,1例为多囊肝、多囊肾)行一期肝肾联合移植.器官切取均采用原位灌注腹部多器官联合切取技术.4例采用改良背驮式(腔静脉成形)原位肝移植术,肾移植采用常规方法;1例采用器官串簇移植技术.结果术后移植肝功能均恢复良好,移植肾发生急性肾功能衰竭2例次.术后并发ARDS 1例次,应激性溃疡1例次.1例患者术后7天死于多器官功能衰竭,其余4例患者经相应治疗后恢复良好.随访13～17个月,4例患者存活.结论肝肾联合移植是治疗肝肾功能不全的有效方法.预防移植肾的急性肾功能衰竭和ARDS是肝肾联合移植的关键环节.

Clinical research on combined liver and kidney transplantation: five cases report

Objective To explore the surgical techniques and clinical treatment experiences of combined liver and kidney transplantation(CLKT). Methods CLKT was performed on 5 patients(2 with liver cirrhosis of hepatitis B and chronic renal failure, 2 with primary liver cancer and chronic renal failure, 1 with autosomal dominant polycystic liver and kidney disease). The donor organs were retrieved by multiple organ harvesting techniques through infusion in situ. Liver transplantation were performed by using modified piggyback orthotopic method(suprahepatic vanacavaplasty) and kidney transplantation with ordinary method in 4 patients. Cluster organ transplantation was carried out in 1 patient. Results All liver transplants functioned well post-transplantation. There were 2 cases of acute renal failure of renal grafts, 1 case of acute respiratory distress syndrome(ARDS) and 1 case of stress ulcer. The patient with cluster organ transplantation died of multi-organ failure 7 days post-operation. The other patients recovered well. After following up for 13 to 17 months, 4 patients survived. Conclusions CLKT is an effective treatment method for liver and renal failure. The prevention of acute renal failure of renal graft and ARDS is the key point for CLKT.