人工肝支持系统联合肝移植治疗晚期重型肝炎的临床经验  

Artificial liver support and liver transplantation for the treatment of severe hepatitis

作　　者：郑树森[1] 徐骁[1] 李兰娟[2] 梁廷波[1] 高峰[1] 王伟林[1] 沈岩[1] 杨芊[2] 

机构地区：[1]浙江大学医学院附属第一医院肝胆胰外科,卫生部多器官联合移植研究重点实验室,杭州310003 [2]浙江大学医学院附属第一医院传染科,浙江省人工肝中心

出　　处：《中华普通外科杂志》2004年第9期520-522,共3页Chinese Journal of General Surgery

基　　金：国家自然科学基金资助项目 (3 0 2 70 3 69);国家重点基础研究发展计划资助项目 (2 0 0 3CB5 15 5 0 1)

摘　　要：目的总结人工肝支持系统 (artificialliversupportsystem ,ALSS)联合肝移植治疗晚期重型肝炎患者的临床经验。方法我院 1993年 4月至 2 0 0 3年 12月共实施 2 2 3例原位肝移植 ,其中 2 3例晚期重型肝炎患者在移植前共进行了 5 8例次的ALSS治疗 ,现就其临床诊治资料进行回顾性分析 ,并与常规内科治疗组、未施行肝移植的单纯ALSS治疗组疗效进行比较。结果ALSS治疗后患者临床症状好转 ,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 12d( 2～ 2 2 6d) ;2 3例患者实施肝移植 ,移植术前血清总胆红素 (TB)水平显著低于患者首次ALSS治疗前水平 (P <0 0 0 1) ;自首次ALSS治疗日计算 ,该组患者等待供肝的中位时间为 12d( 2～ 2 2 6d) ,本组晚期重型肝炎患者半年存活率达 73 9% ,显著高于常规内科治疗组和未施行肝移植的ALSS治疗组 (P <0 0 0 1)。结论ALSS能显著改善晚期重型肝炎病情 。Objective To sum up the experience of application of artificial liver support system (ALSS) combined with liver transplantation(LT) in the treatment of end stage severe hepatitis.Methods Clinical data of 23 patients with end stage severe hepatitis receiving ALSS treatment prior to liver transplantation among 223 patients who underwent LT consecutively between April 1993 and December 2003 were analyzed retrospectively. Twenty three patients with end stage severe hepatitis received 58 courses of ALSS prior to liver transplantation. The 6 month survival rate was compared to those in non ALSS non LT group and non LT group.Results ALSS treatment facilitated improvement of liver function, endotoximia, and the tolerance to LT, thus provided a bridge time for attaining the donor liver. The total serum bilirubin level at LT was significantly lower than that before the first run of ALSS ( P <0 001).The 6 month survival rate of 73 9% was significantly higher than those in control groups. Conclusions The timely application of ALSS provides valuable liver function support for 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.

关 键 词：ALSS 治疗组 肝移植 患者 重型肝炎 晚期 人工肝支持系统 临床经验 

分 类 号：R657.3[医药卫生—外科学]