急诊成人右半肝活体肝移植治疗重型肝炎九例报告  

Adult living donor liver transplantation using right lobe for severe hepatitis in emergency:a report of 9 cases

作　　者：张峰[1] 王学浩[1] 李相成[1] 孔连宝[1] 孙倍成[1] 李国强[1] 钱晓峰[1] 成峰[1] 陆森[1] 吕凌[1] 

机构地区：[1]卫生部活体肝移植重点实验室南京医科大学第一附属医院肝脏移植中心,南京210029

出　　处：《中华外科杂志》2007年第15期1019-1022,共4页Chinese Journal of Surgery

基　　金：国家自然科学基金(3071992);江苏省医学领军人才基金(2006-50)

摘　　要：目的探讨急诊成人右半肝活体肝移植治疗重型肝炎的疗效。方法 2002年9月至2005年8月期间共施行急诊成人右半肝活体肝移植治疗重型肝炎患者9例,回顾性分析所有患者的临床和随访资料。结果 9例患者术前肝功能均为 Child C 级,MELD 评分为26.7±8.8,术前主要并发症为肝性脑病5例,严重电解质紊乱3例,肾功能衰竭2例,消化道出血1例。供、受者手术均顺利。术后主要并发症:急性肾功能衰竭3例,肺部感染2例,肝移植相关性脑病1例。未出现原发性肝脏无功能及血管、胆道系统并发症。1年生存率为55.6%。全组供者未出现严重并发症及死亡。结论急诊成人活体肝移植治疗重症乙型肝炎可明显提高患者生存率,供者术前评估必须充分以确保安全。Objection To evaluate the outcome of emergency adult right lobe living donor liver transplantation for fulminant hepatitis. Methods Nine cases of adult right lobe living donor liver transplantation were performed from September 2002 to August 2005, the clinical and follow-up data was analyzed. Results According to Child Pugh Turcotte （CPT） classification, 9 patients were classified as grade C before transplant. The Model for End-Stage Liver Disease （MELD） scores of these patients were 26. 7 ± 8. 8. The principal pre-transplant complications included hepatic encephalopathy （5 cases ）, electrolyte disturbance （ 3 cases ）, renal failure （ 2 cases ）, gastrointestinal bleeding （ l case）. The operations in donors and recipients were all successful. The post-transplant complications induced pulmonary infection in 2 patients, acute renal failure in 3 and transplantation related encephalopathy in 1. There were no primary graft non-function and no blood vessel and bile tract complications occurred. One-year survival rate was 55.6%. No serious complication or death found in donors. Conclusions Emergency adult to adult living donor liver transplantation is an effective treatment for fulminant hepatitis but the safety of the donors should be assessed strictly preoperation.

关 键 词：肝移植 活体供者 肝炎 乙型 

分 类 号：R657.3[医药卫生—外科学]