肝肾联合移植治疗肝肾功能衰竭的体会(附6例报告)  

Experience of simultaneous liver-kidney transplantation for combined hepatic and renal failure:6 cases report

作　　者：吴星宇[1] 仇毓东[1] 施晓雷[1] 吴亚夫[1] 江春平[1] 周建新[1] 丁义涛[1] 

机构地区：[1]南京大学附属鼓楼医院肝胆外科,210008

出　　处：《器官移植》2011年第5期266-268,272,共4页Organ Transplantation

基　　金：国家传染病防治重大专项(2008ZX10002-026)

摘　　要：目的总结肝肾联合移植的治疗体会。方法收集6例接受同种异体一期肝肾联合移植术患者的临床资料,其中1例为簇式肝肾联合移植,余5例采用经典式肝肾联合移植。对其手术时间、无肝期、术中出血量、术中使用体外静脉转流或连续性静脉-静脉血液滤过的情况及效果,以及预后进行分析。结果 6例均顺利完成手术。手术时间12～18h,中位数15h。无肝期70～240min,中位数130min。术中出血量5300～18000ml,中位数9525ml。术中采用体外静脉转流1例,使用连续性静脉-静脉血液滤过4例,无转流及滤过1例。行簇式肝肾联合移植的1例患者术后29h出现腹腔出血,经再次手术止血,后发生移植肾无功能并继发腹腔感染,术后10d死亡。1例经典肝肾联合移植患者术后出现移植肝无功能并继发弥散性血管内凝血,术后7d死亡,1例患者因移植物功能障碍术后82个月死亡。其余3例患者术后生存良好,分别存活了1个月、64个月和73个月。结论严格掌握肝肾联合移植的适应证。肝肾联合移植术式以经典式肝肾联合移植为宜。术中应用连续性静脉-静脉血液滤过或体外静脉转流有助于血流动力学稳定。Objective To summarize the experience of combined liver-kidney transplantation for liver and renal failure. Method Clinical data of 6 patients underwent allogeneic simultaneous combined liver-kidney transplantation were collected, among which, one recipient underwent cluster type liver-kidney transplantation and the other five recipients underwent classic type liver-kidney transplantations. The operation time, anhepatic phase, introperative amount of bleeding, the application and efficacy of venous-venous shunting or continuous venovenous hcmofihration （CVVH） , and prognosis were analyzed. Results The operations were suc- cessfully performed in 6 cases. The operation time was ranging from 12 hours to 18 hours with a median time of 15 hours. The mean anhepatic phase was 130 minutes （ ranging from 70 minutes to 240 minutes）. And the total amount of perioperative blood loss was 5 300-18 000 ml （median 9 525 M）. During the operation, one case underwent extracorporeal venous bypass, 4 cases underwent CVVH, and the other case underwent neither extracorporeal venous bypass nor CVVH. One recipient with cluster type liver-kidney transplantation developed abdominal bleeding at 29 hours ＇after operation and the bleeding was stopped by reoperation. However, the patient developed transplant kidney failure and secondary celiac infection, and died on day 10 after operation. One case underwent elassic type liver-kidney transplantation, developed transplant liver failure and secondary diffuse intravascular coagulation （DIC） , and died on day 7 after operation. One case died 82 months after operation due to graft dysfunction. The other 3 cases still survived after operation and have survived for 1 month, 64 months and 73 months respectively. Conclusions Transplantation surgeons should closely adhere to the indications of combined liver-kidney transplantation. It is advisable to use classic type liver-kidney transplantation and apply CVVH or extracorporeal venous bypass for keeping the stability of blood flow.

关 键 词：肝肾联合移植 终末期肝病 肾衰竭 肝肾综合征 连续性静脉-静脉血液滤过 体外静脉转流 

分 类 号：R657.3[医药卫生—外科学]