肝移植治疗终末期肝病的单中心生存分析  

Orthotopic liver transplantion for end stage liver disease 10 years follow-up from a single center

作　　者：卢倩[1] 杨占宇[1] 刘祥德[1] 廖睿[1] 杨智清[1] 董家鸿[2] 

机构地区：[1]第三军医大学附属西南医院全军肝胆外科研究所,重庆400038 [2]解放军总医院肝胆外科

出　　处：《中华器官移植杂志》2011年第2期99-103,共5页Chinese Journal of Organ Transplantation

摘　　要：目的总结肝移植受者长期生存状态，探讨影响受者长期存活的因素。方法对391例接受肝移植治疗的终末期肝病患者的临床资料进行回顾性分析。根据受者的基础疾病分类分别计算其存活率，并对随访期间原发疾病复发、死亡原因、并发症发生率及其病种和时间分布等资料进行分析，评价影响移植后原发疾病复发和并发症的相关因素。结果进入随访期的受者共有331例，随访时间8～120个月。良性终末期肝病受者术后1、3、5和10年总体存活率分别为86％、85％、83％和83％，乙型肝炎病毒（HBV）相关肝硬化与重型肝炎受者术后长期存活率的差异无统计学意义（P〉0．05）。符合米兰标准的肝癌患者术后1、3、5和10年存活率分别为96％、87％、87、％和87％，超出米兰标准的肝癌患者分别为42％、26％、24％和24％，二者间同期存活率的差异有统计学意义（P〈0．01）。原发性肝癌患者肝移植后总体肿瘤复发率为54．3％，符合和超出米兰标准的肝癌患者肝移植后肿瘤复发率分别为4．3％和72．7％（P〈0．01），肿瘤复发是肝癌患者随访期主要的死亡原因，占所有死亡事件的95．5％。全组HBV再感染率为6．0％，且多存在HBVDNA的变异，调整抗病毒药物可有效控制HBV再感染。胆道并发症总体发生率为11．8％，肝内胆道狭窄为主要表现形式（占56．5％），严重影响移植肝功能及受者生存质量。钙调磷酸酶抑制剂相关性肾损害发生率为8．2％，早期发现和处理可避免进展为不可逆肾损害。结论肝移植是治疗终末期肝病的安全、有效手段，在严格选择适府证、有序随访管珲前提下，肝移植爱者可长期存活，目存活质量良好。Objective To investigate the survival condition of the liver transplant recipients and determine the factors which influence the long time survival. Methods Retrospective study of the followup data of the orthotopic liver transplantation recipients during 1999- 2009 was performed. The survival rate of different primary disease was analyzed respectively. The recurrence of the primary disease, mortality and morbidity was also analyzed. Results 331 recipients were follwed up. The follow- up duration ranged from 8-120 months. The 1 , 3-, 5-, and 10 year survival rate of patients with benign end-stage liver disease was 86 %, 85 %, 83 %, and 83%, respectively. There was no difference in the long- term survival rate between the patients with hepatitis B virus （HBV）-related cirrhosis and severe liver failure. The 1-, 3-, 5-, and 10-year survival rate of patients with HCC matching Millan criteria was 96 %, 87%, 87 %, and 87 %, while those of HCC exceeding Millan criteria were 42 %,26 %,24 %,24 % resepectively. There was significant difference between them at the same period （P〈0. 01）. The total recurrent rate of HCC recipient was 54. 3%, and that of HCC matching and exceeding Millan criteria was 4. 3 % and 72. 7 % respectively （P〈 0. 01）. Tumor recurrence was the main cause of death of the malignancy. The HBV recurrent rate was 6. 0 ~, and all the cases were controlled by changing the antivirus regimen. The morbidity of billiary complication was 11.8%, and intrahepatic biliary stricture was the most common type. CNIs-related renal impairment morbidity was 8. 2 % and the damage was reversible in condition of early diagnosis and treatment. Conclusion Orthotopic liver transplantation is an effective and safe treatment for end stage liver disease. The LTx recipients can get long time survival with perfect quallity life under proper medical supervision.

关 键 词：肝脏移植 长期生存 终末期肝病 

分 类 号：R657.3[医药卫生—外科学]