同种异体原位肝脏移植术治疗终末期肝病43例  

Orthotopic liver transplantation for treating end-stage liver disease:experiences in 43 cases

作　　者：臧运金[1] 李志强[1] 郭源[1] 李自强[1] 田根东[1] 孙凯[1] 于振海[1] 沈中阳[1] 

机构地区：[1]山东省千佛山医院肝脏移植中心东方器官移植中心山东分中心,山东济南250014

出　　处：《中国现代普通外科进展》2005年第6期365-366,369,共3页Chinese Journal of Current Advances in General Surgery

基　　金：山东省科技厅2002年"数字山东"重点科技攻关项目(2002-BBI-DCA1)

摘　　要：目的:总结同种异体肝脏移植手术的临床经验。方法:43例44次手术(再次肝移植1例)中,原发性肝癌19例,终末期乙型肝炎肝硬化16例,终未期丙型肝炎肝硬化1例,终末期酒精性肝硬化2例,原发性胆汁性肝硬化3例,Wilson综合症2例,二次肝移植1例。结果:行改良背驮式9例,经典非转流术式35例次,其中1例行减体积肝移植(左肝外叶切除)。手术移植成活率100%,无原发性移植肝无功能和功能延迟恢复发生。手术成功率88.4%(38/43),其中良性终末期肝病和肝癌97.1%(33/34),重症肝炎为55.6%(5/9);围手术期病死率:11.6%(5/43)。存活2年以上5例,1年以上3例,目前存活32例。结论:良性终末期肝病和早期肝癌肝移植手术效果良好,合理的手术方式,良好的供体质量,科学的围手术期管理是保证手术成功的重要条件。乙肝和肝癌等移植后易复发疾病的控制对于提高肝移植术后的长期存活率非常重要。Objective ：To summarize the experiences of orthotopic liver transplantation（OL Tx）for treating end-stage liver diseases. Methods ：To analyze 44 times of OLTx in 43 patients with end-stage liver diseases which included one case who hag received retransPlantation,including surgical procedures,mobidity and montality,survival rate and survival period,suoeess rate, etc. Results ：Modified Piggy-baG, OLTx was performed on 9 cases,and stundand OLTx without venovenous bypass was performed on 35 cases, which including one case recepted reduced-size OLTx. The graft survival rate was 100%. No primary graft failune and delayed function were occured. The overall success rate was 88. 496 （38/43）, however, the success nate was 97. 196（33 / 34） in benign end-stage Liver diseases and liver cancer and 55.6%（5/9）. The perioperative montality rate was 11.6%（5/43）. During the follow-up,5 patients survived more than two years,3 cases survived more than one years,and 32 cases survive with good quality of tife. Conclusion ： QLTx is the best therapy for patients with fulminant hepatic failure（FHF）and end-stage liver diseases.The results of QLTx in benign liver cirnhosis and early hepatocellular carcinoma（HOO） were better than the FHF and advanced HCC. The prequtsite factors for successful QLTx include strict indioation seleotion,satisfaotory liver donor,optimal surgical procedures and timing, and soientifio perioperative manaaement. In order to prolong the patients＇ survival period, it is very important to control the recurrence of hepatitis B and hepatic carcinoma.

关 键 词：肝移植 肝硬化 肝肿瘤 

分 类 号：R657.3[医药卫生—外科学] R512.620.5[医药卫生—临床医学]