肝移植治疗原发性胆汁性肝硬化临床疗效分析  

Clinical analysis on liver transplantation for primary biliary cirrhosis

作　　者：傅斌生[1] 汪根树[1] 李华[1] 张彤[1] 易述红[1] 张剑[1] 许赤[1] 杨扬[1] 陈规划[1] 

机构地区：[1]中山大学附属第三医院肝移植中心中山大学器官移植研究所广东省器官移植研究中心,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2012年第2期16-20,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家重点基础研究发展计划(973计划)课题(2009CB522404);广东省科技计划项目重大专项(2007A032000001);教育部新教师基金(20100171120084;20100171120087)

摘　　要：目的探讨肝移植治疗原发性胆汁性肝硬化（PBC）患者的安全性和临床疗效。方法回顾性分析2003年9月至2009年7月在中山大学附属第三医院肝移植中心因PBC接受肝移植术的8N患者的临床资料。患者均签署知情同意书，符合医学伦理学规定。患者均为女性，年龄39-63岁，平均52岁。肝功能Child-Pugh分级B级2例、c级6例，终末期肝病模型（MELD）评分18-28分。手术方式均采用同种异体改良背驮式原位肝移植术（附加腔静脉整形）。术后免疫抑制治疗采用他克莫司或环孢素联合肾上腺皮质激素（激素）的二联或三联免疫抑制方案，3例患者加用了吗替麦考酚酯。记录患者的手术时间、无肝期时间、术中出血量、术后住院时间，了解围手术期并发症发生及死亡情况，术后随访期间患者手术并发症、PBC复发和存活情况。结果所有患者均手术顺利，手术时间（364±100）min，无肝期时间（38±11）min，术中出血量（1875±525）ml，术后住院时间37。154d，中位时间84d。1例患者于术后5d死于肺部感染和多器官功能衰竭；3例患者于术后1个月内出现急性排斥反应，给予加强免疫抑制治疗后痊愈。存活的7例均获得随访，随访时间28。92个月，中位随访时间51个月。随访期间未发现PBC复发。随访期间除1例术后964d死于脓毒症和移植肝失功外，其余6例存活，存活3-4年者3例，存活〉5年者3例。结论肝移植是治疗PBC安全且有效的方法，手术时机的正确把握和术后有效的免疫抑制治疗是提高肝移植临床疗效的关键。Objective To evaluate the safety and clinical effect of liver transplantation for treating primary biliary cirrhosis （PBC）. Methods The clinical data of 8 cases with PBC who underwent liver transplantation in the Third Affiliated Hospital of Sun Yat-sen University from September 2003 to July 2009 were analyzed retrospectively. Local ethical committee approval had been received and that the informed consent of all participating subjects was obtained. All the patients were female, aged from 39 to 63 years old with an average age of 52 years old. The Child-Pugh grade was B in 2 cases and C in 6 cases. The model for end-stage liver disease （MELD） scores of the 8 patients was 18-28. All the patients received modifiedpiggyback liver transplantation with venacavaplasty and joint/triple immunosuppressive regimen of taerolimus or cyclosporine A plus prednisone after operation. Mycophenolate mofetil was also applied in 3 patients at the same time. The duration of the operation, anhepatic phase time, volume of intraoperative bleeding and the postoperative hospital stay were recorded. The occurrences of their perioperative complications and death were observed. The operative complications, recurrences of PBC and survival time were investigated during follow up. Results The operations of all the patients were successful. The duration of the operation was （364±100）min. The anhepatie phasetime was （38±11）rain. The volume of intraoperative bleeding was （ 1 875±525）ml. The postoperative hospital stay was 37-154 d with the median of 84 d. One patient died of lung infection and multiple organ failure 5 d after operation. Three patients suffered from episodes of acute cellular rejection within 1 month after operation but were cured when immunosuppressive therapy strengthened. The 7 survived patients were followed up from 28 months to 92 months with the median follow-up time of 51 months. One patient died of sepsis and graft dysfunction 964 d after operation and the other 6 patients survived. Three cases had su

关 键 词：肝移植 原发性胆汁性肝硬化 手术时机 他克莫司 吗替麦考酚酯 

分 类 号：R657.3[医药卫生—外科学]