同种异体原位肝脏移植13例次临床经验

目的 总结原位肝脏移植经验。方法 对12例患者实施13例次原位肝脏移植(包括1例再次肝移植),其中5例终末期肝硬化、4例原发性肝癌、1例肝癌术后肝功能衰竭、1例肝豆状核变性、1例慢性肾功能衰竭合并肝炎后肝硬化。手术方式:经典原位肝移植10例,改良背驮式肝移植2例,再次肝移植1例。结果 全组成功9例,最长存活超过2年;围手术期死亡4例,直接死亡原因脑出血1例、急性呼吸窘迫综合征1例、急性肾功能衰竭1例、肝动脉血栓1例。结论 肝脏移植是治疗各种终末期肝病的有效手段,但应严格掌握适应证,减少术后并发症的发生是提高肝移植成功率及长期存活率的关键。

Clinical experience with 13 cases of orthotopic liver transplantation

Objective To review our experience with orthotopic liver transplantation. Methods Thirteen liver transplantation were performed in 12 patients (including one liver retransplantation), of whom 5 patients received the transplantation for end stage liver cirrhosis, 4 for primary liver carcinoma, 1 for liver failure after hepatectomy for liver cancer, 1 for Wilson's disease, and 1 for chronic renal failure and liver cirrhosis. Retransplantation was done in 1 patient for chronic graft rejection. Of the 13 operations, 10 underwent the classical procedures of orthotopic liver transplantation, while 2 adopted modified piggyback technique, with 1 of the patients receiving retransplantation. Results Nine patients survived the transplantation with the longest survival over 2 years. Four patients died in the perioperative period, due to intracerebral bleeding, adult respiratory distress syndrome, acute renal failure and hepatic artery thrombus, respectively. Conclusions Liver transplantation is an effective treatment for various end-stage liver diseases. Strict patient selection, appropriate timing of the operation and proper perioperative care are all essential for the success of liver transplantation.