重症肝炎行原位肝移植术及肝肾联合移植术的疗效比较  

Combined liver-kidney transplantation and orthotopic liver transplantation in the treatment of severehepatitis B

作　　者：戚晓升[1] 彭志海[1] 陈国庆[1] 徐军明[1] 钟林[1] 孙星[1] 范昱 

机构地区：[1]上海交通大学附属第一人民医院普外科,200080 [2]移植泌尿科

出　　处：《中华普通外科杂志》2011年第10期804-806,共3页Chinese Journal of General Surgery

摘　　要：目的总结重症肝炎患者行原位肝移植或肝肾联合移植的结果，探讨肝肾联合移植的手术适应证。方法分析52例重症肝炎患者单纯行原位肝移植（orthotopiclivertransplantation，OLT）和肝肾联合移植（combinedliver—kidneytransplantation，CLKT）两组患者死亡率、术后。肾功能不全的发生率、ICU天数、住院天数等。结果CLKT组患者术前肾功能明显差于OLT组，术后发生严重感染的患者明显多于OLT组。但OLT组中28例（70％）患者术后早期发生肾功能不良，其中11例需血液透析；而CLKT组患者中需血液透析仅2例，两组比较差异有统计学意义（P〈0．01）。CLKT组患者在围手术期2例（16．7％）死亡。OLT组围手术期死亡16例（40％），其中死于急性肾衰9例，两组死亡率比较差异有统计学意义（P〈0．01）。结论重症肝炎患者若术前肾功能较差，术后易并发严重感染，肝移植后急性肾衰的发病率和死亡率较高，可考虑行CLKT术。Objective To compare orthotopic liver transplantation （OLT）and combined liverkidney transplantation （CLKT） in the treatment of severe hepatitis B. Methods In this study 52 patients of severe hepatitis B were allocated to OLT （40 cases） or CLKT （ 12 cases） at our department from Jan. 2001 to Sep. 2005. The perioperative complications and the result of follow-up were analyzed. Results The preoperative renal functions in CLKT cases were severer than that in OLT eases. Postoperative severe infection was more common in CLKT cases than that in OLT eases. In OLT group 28 patients （70%） suffered from early posttransplant renal dysfunction, among them 11 patients needed dialysis, whilst there were 2 （16. 7% ） patients who needed dialysis in CLKT group （P 〈 0.01 ）. The posttransplant mortality in OLT group was 40% （ n = 16）, significantly higher than that in CLKT （ 16. 7%, n = 2 ） （ P 〈 0. 01 ）. In OLT group, 9 cases developed severe renal failure and died. No one died of renal failure in CLKT group. Conclusions The prognosis is more favorable to perform CLKT in patients who suffered from severe hepatitis B with chronic renal dysfunction before transplantation.

关 键 词：肝炎 乙型 肝移植 肝肾联合移植 

分 类 号：R657.3[医药卫生—外科学]