肝移植治疗急性肝功能衰竭的临床疗效分析  

Therapeutic effect of liver transplantation on acute liver failure

作　　者：彭志海[1] 邢同海[1] 戴德坚[1] 陈国庆[1] 徐军明[1] 钟林[1] 李涛[1] 孙星[1] 王书云[1] 王兆文[1] 

机构地区：[1]上海交通大学附属上海市第一人民医院泌尿外科,200080

出　　处：《中华医学杂志》2007年第14期953-955,共3页National Medical Journal of China

摘　　要：目的评价急性肝功能衰竭肝移植患者的近期及远期生存情况和分析影响移植疗效的相关因素。方法回顾性分析2001年1月至2004年12月在我院连续施行的318例肝移植资料(随访至2005年12月),根据 UNOS 肝功能分级标准,对受体的术前状态进行评估,其中包括54例急性肝功能衰竭(UNOS1和2A)和264例慢性肝病肝硬化(UNOS2B 和3),并统计了术后并发症的发生率、再移植率、再移植原因和死亡原因。结果术前肝功能状态为 UNOS2B 和3的移植组,围手术期死亡率为3.7%,术后并发症发生率为16.7%,再移植率1.1%,其1、3年生存率分别为91.3%和86.4%。术前肝功能状态为 UNOS1和2A 的肝移植组,围手术期死亡率为22.6%,术后并发症发生率为55.6%,再移植率18.5%,其1、3年生存率分别为74.1%和68.5%。结论肝移植效果主要取决于肝外器官功能和术前肝功能状态,术前肝功能状态为 UNOS2B 和3的慢性肝病肝硬化患者肝移植后近期和远期疗效较好,而术前肝功能状态为 UNOS1和2A 的急性肝功能衰竭患者则围手术期死亡率较高。Objective To evaluate the short-term and long-term outcomes of emergent liver transplantation recipients with acute liver failure and to identify factors that influenced these outcomes. Methods 318 consecutive patients who underwent liver transplantations between January 2001 and December 2004 were analyzed retrospectively （ all the cases were followed up to December 2005）. According to UNOS grading scale, all recipients preoperative status were evaluated. 54 patients were acute liver failure （Group Ⅰ, UNOS 1 and 2A）, and the other 264 cases were chronic liver diseases （Group Ⅱ, UNOS 2B and 3）. The postoperative effects in different groups were compared, including the survival rates, incidences of complications, rates and causes of retransplantation, rates and causes of death. Results Comparing UNOS2B/3 to UNOS1/2A, the perioperative mortality were 3. 7%; 22.6%, the rate of complications 16.7%; 55.6%, 1 year survival rate 91.3%; 74.1%, 3 year survival rate 86.4%; 68.5%, the retransplantation rate 1.1% ; 18. 5% respectively. Conclusion Since the technique of liver transplant is very advanced, the effect of surgery is mainly depended on the function of liver and other organs in patients. The recipients with UNOS2B/3 have better short-term and long-term outcomes as comparing to UNOS1/2A. In addition, the recipients with UNOS1/2A are burdened with much higher mortality.

关 键 词：肝移植 急性肝功能衰竭 生存率 再移植 

分 类 号：R657.3[医药卫生—外科学]