肝移植治疗门静脉高压上消化道出血的疗效分析  

Analysis on Effect of Liver Transplantation in Treatment of Upper Gastrointestinal Hemorrhage in Patients with Portal Hypertension

作　　者：俞军[1] 张武[1] 张珉[1] 王伟林[1] 周琳[1] 沈岩[1] 汤洒潇[1] 程龙宇[1] 谢尚奋[1] 陈智贇[1] 郑树森[1] 

机构地区：[1]浙江大学医学院附属第一医院肝胆胰诊治中心,浙江杭州310003

出　　处：《中国普外基础与临床杂志》2013年第1期24-28,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：卫生行业科研专项项目基金(项目编号:201002015)~~

摘　　要：目的探讨肝脏移植治疗门静脉高压症所致上消化道出血的可行性及安全性,并与传统手术的疗效进行比较。方法回顾性分析2009年2月至2012年2月期间浙江大学附属第一医院肝胆胰诊治中心收治的303例门静脉高压症合并上消化道出血患者的临床资料。其中101例患者接受肝移植治疗(肝移植组),202例患者接受常规手术治疗(常规手术组),术后随访8～44个月,平均26个月。结果常规手术组患者术前肝功能明显优于肝移植组(P<0.01),2组患者总体死亡率比较差异无统计学意义〔7.4%(14/189)比3.0%(3/101),P=1.00〕。肝移植组术后再出血率为2.0%(2/101),低于常规手术组的9.5%(18/189),P<0.05。肝移植组术后内镜下曲张静脉消失率为86.1%(87/101),高于常规手术组的54.5%(86/189),P<0.01。结论肝移植治疗门静脉高压症所致上消化道出血是安全可靠的。有出血史但术前肝功能尚好的患者,接受常规手术后能维持较好的肝脏功能和生活质量。终末期肝病门静脉高压症患者,肝移植是唯一的治愈方案。Objective To explore the feasibility and safety of liver transplantation（LT） in treatment of upper gastrointestinal hemorrhage in patients with portal hypertension,and to compare the therapeutic effects with conventional operation（CO）.Methods The clinical data of 303 patients with bleeding portal hypertension from Feb.2009 to Feb.2012 in the department of hepatobiliary and pancreatic surgery of First Affiliated Hospital of Zhejiang University were retrospectively analyzed.One hundred and one patients received LT procedure（LT group）,whereas the other 202 patients received CO procedure（CO group）.Postoperative follow-up period was 8-44 months（average 26 months）.Results Liver function before operation in CO group was significantly better than that in LT group （P0.01）.The mortality of CO group and LT group were 7.4% （14/189） and 3.0% （3/101,P=1.00）,respectively.The rebleeding rate of patients underwent LT was 2.0% （2/101）,significantly lower than that of CO group（9.5% （18/189）,P0.05）.The vanish rate of esophagogastric varice in patients underwent LT was 86.1% （87/101）,significantly lower than that of CO group（54.5% （86/189）,P0.01）.Conclusions LT treatment for bleeding portal hypertension is feasible and safe.Patients with good liver function despite hemorrhage history may be managed satisfactorily with conventional surgery.LT is the only curative treatment for patients with portal hypertension in end-stage liver disease.

关 键 词：肝移植 门静脉高压症 上消化道出血 

分 类 号：R657.34[医药卫生—外科学] R657.3[医药卫生—临床医学]