急诊成人活体右半肝肝移植治疗重型肝炎肝功能衰竭的临床研究  

Emergency right lobe adult-to-adult live-donor liver transplantation for the treatment of acute liver failure following severe hepatitis

作　　者：卢实春[1] 戴军[1] 王孟龙[1] 张振[1] 赖威[1] 武聚山[1] 林栋栋[1] 郭庆良[1] 李宁[1] 

机构地区：[1]首都医科大学附属北京佑安医院肝胆外科暨肝移植中心,100069

出　　处：《中华外科杂志》2008年第19期1453-1456,共4页Chinese Journal of Surgery

基　　金：国家自然科学基金资助项目（30671977）;首都医学发展基金资助项目（2005-2034）

摘　　要：目的探讨急诊成人活体右半肝肝移植在治疗重型肝炎肝功能衰竭中的作用。方法2007年4至12月接受活体肝移植患者中，共有10例接受了急诊活体肝移植治疗（4例为慢性重型肝炎、6例为急性肝功能衰竭；9例为乙型肝炎、1例为药物性肝功能衰竭）。终末期肝病模型（MELD）评分平均为33．22±6．55。ABO血型相同者8例，相容者2例，Rh不相容者1例。对术后的相关指标进行前瞻性分析。结果1例术后发生腔静脉血栓形成致急性肾功能衰竭死亡，另1例发生肝动脉血栓形成致移植物失功能而死亡，余受者和所有供者均恢复良好，受者随访6～14个月，中位生存已达8．5个月，均无并发症发生。平均移植物重量和受者体重比值为（1．19±0．14）％，移植物容积和受者估计标准肝容积比为（65．13±8．75）％；带肝中静脉右半肝移植物3例，不带肝中静脉右半肝合并Ⅴ段和Ⅷ段流出道重建3例，不带肝中静脉右半肝4例。术后血清肌酐、内毒素水平、凝血酶原活动度及总胆红素分别在术后第3、7、14、28天恢复到正常水平。结论急诊成人活体右半肝肝移植治疗重型肝炎肝功能衰竭效果满意，作为重型肝炎肝功能衰竭的抢救治疗疗效确切。Objective To research the clinical feasibility of emergency right lobe adult-to-aduh live-donor liver transplantation in treating acute liver failure following severe hepatitis. Methods Consecutive ten severe hepatitis patients （4 acute-on-chronic severe hepatitis and 6 acute severe hepatitis;9 caused by HBV and 1 with drug-induced acute liver failure） underwent emergency right lobe adult-to-adult live-donor liver transplantation in our hospital from April 2007 to December 2007. The ^-x ± s of model for end-stage liver disease score was 33.22 ± 6. 55. The outcomes of these recipients were prospectively analyzed. Results Among them,8 ABO blood group were identical and 2 compatible. One was Rh sub-group negative. Except 2 recipients died （ 1 acute renal failure caused by veno cava thrombosis, 1 liver graft lose caused by hepatic artery thrombosis） ,the rest of recipients（80% ） and all donors were safe. The mean graft-to-recipient weight ratio was （1. 19 ± 0. 14）%, and graft volume to recipient estimated standard liver volume ratio was （ 65.13 ± 8.75 ） %. Right lobe grafts with middle hepatic vein （MHV） 3 cases, without MHV 4 cases, without MHV but followed by Ⅴ and Ⅷ hepatic vein outflow reconstruction 3 cases. Encouraging outcome was achieved in this group of recipient ： elevated serum creatinine, serum endotoxin, decreased serum prothrombin aetivity（PTA） and total bilirubin returned to normal about on postoperative day （POD） 3, POD 7, POD 14 and POD 28, respectively. Conclusions Outcomes of emergency right lobe adult-to-adult live-donor liver transplantation for acute hepatic failure following severe hepatitis are fairly encouraging and acceptable. emergency right lobe adult-to-adult live-donor liver transplantation is an effective and life-saving modality for acute liver failure following severe hepatitis.

关 键 词：肝移植 肝功能衰竭 急性 肝炎 

分 类 号：R686[医药卫生—骨科学]