肝移植治疗药物性急性肝衰竭的体会(附8例报告)  

Experience of orthotopic liver transplantation in treating patients with drug-induced acute hepatic failure:8 cases report

作　　者：王营[1] 曲明[1] 史彦芬[1] 杜英东[1] 尹惠生[1] 张成钧[1] 刘延军[1] 

机构地区：[1]山东烟台解放军107中心医院肝胆外科,264002

出　　处：《器官移植》2011年第6期342-344,349,共4页Organ Transplantation

摘　　要：目的探讨肝移植治疗药物性急性肝衰竭的疗效。方法药物性急性肝衰竭患者8例,术前肝功能Child-Pugh分级均为C级,均合并肝性脑病(Ⅲ～Ⅳ期)。所有患者均行经典原位肝移植,供体均为尸体供肝,均未行静脉转流。术后予免疫诱导、免疫抑制治疗,并予抗感染及支持治疗。结果 8例患者均顺利完成肝移植手术。术后1例女性患者并发原发性移植肝无功能,死亡。余7例患者于术后16～72h苏醒。1例发生胆道铸型结石,手术取石效果不佳,予再次肝移植,行胆总管空肠吻合术,术后发生吻合口漏死亡。其余6例存活患者均痊愈,生活状况良好。其中2例曾发生急性呼吸窘迫综合征,行气管切开、呼吸机辅助呼吸,最后康复出院。结论对于保守治疗无效的药物性急性肝衰竭,肝移植是唯一有效的治疗措施。Objective To evaluate orthotopic liver transplantation in treating patients with drug-induced acute hepatic failure. Methods Clinical data of 8 patients with drug-induced acute liver failure were retrospectively analyzed, whose preoperative liver function were Grade C in Child-Pugh. And the 8 patients were all combined with hepatic encephalopathy. Classic orthotopic liver transplantation was performed on all the patients with cadaver graft. And no venous bypass was used. Immunity induction, immunosuppressive therapy, anti-infection and supporting therapy were given after transplantation. Results Liver transplantations were suc- cessfully performed on 8 patients. One female patient suffered primary nonfunction and died after the operation. The other 7 patients＇ consciousness recovered in 16-72 hours after the operation. One of them developed biliary casting calculus and was concerted to retransplantation with choledochojejunostomy after failure of stone extraction, and died of anastomotic leakage. The other 6 patients recovered and had a good living status. Once two of the six patients had complicated with acute respiratory distress syndrome, underwent tracheotomy, assisted respiration with ventilator, and recovered in the end. Conclusion Orthotopic liver tranplantation is the only effective way to treat drug-induced acute liver failure after invalid conservative treatment.

关 键 词：药物性肝损害 肝衰竭 急性 肝性脑病 肝移植 对乙酰氨基酚 

分 类 号：R575.3[医药卫生—消化系统]