再次肝移植临床分析  

Clinic analysis Of Liver Retransplantation

作　　者：张寅[1] 徐军明[1] 许勇刚[1] 翁明哲[1] 张金彦[1] 黄力[1] 王兆文[1] 陈国庆[1] 彭志海[1] 

机构地区：[1]上海交通大学附属第一人民医院,上海200080

出　　处：《现代实用医学》2011年第7期730-731,737,F0003,共4页Modern Practical Medicine

摘　　要：目的总结再次肝移植的临床经验,评估手术疗效。方法结合术后随访,回顾性研究29例再次肝移植患者的临床资料。结果再次肝移植率为5.2%(29/561)。再次移植主要原因为胆道并发症(44.8%)、血管并发症(20.6%)、原发病复发(17.2%)、跨血型肝移植后(10.3%)及慢性排斥反应(6.9%)。围手术期并发症发生率为55.2%(16/29),主要并发症包括腹内出血、急性肾功能不全、血管并发症及感染等。围手术期病死率为24.1%。再次肝移植患者术后1、3及5年生存率分别为65.5%、51.7%和47.7%。结论尽管围手术期并发症发生率及病死率较高,但再次肝移植仍不失为治疗首次移植物失功能的有效手段。选择合理的手术指征,把握合适的手术时机,有助于提高再次肝移植的疗效。Objective ？To summarize the clinical experiences of liver retransplantation（LrT） and to evaluate the outcomes of the operation.Methods Combined with postoperative follow-up,clinical data of 29 cases with LrT were retrospectively analyzed.Results The LrT rate was 5.2%,and indications for LrT were biliary complications（44.8%）,vascular complications（20.6%）,recurrence of primary disease（17.2%）,ABO-blood-type-incompatible transplantation（10.3%） and chronic rejection（6.9%）.Perioperative complication rate was 55.2%,including intra-abdominal bleeding,acute renal failure,vascular complications and infections.The perioperative mortality was 24.1%（7/29）.The cumulative survival at 1,3 and 5 years after operation was 65.5%,51.7% and 47.7% in LrT patients.Conclusions Although the incidences of perioperative complications and mortality are high,LrT is an effective way.Effect of LrT can be improved by choosing reasonable indications for surgery and seizing appropriate operation time.

关 键 词：肝移植 再手术 生存率 

分 类 号：R65[医药卫生—外科学]