36例自体肝移植的临床疗效  

Clinical study of autologous liver transplantation： a report of 36 cases

作　　者：叶放发[1] 范晓礼[1] 明英姿[2] 王彦峰[1] 成柯[2] 彭贵主[1] 李弦[1] 范林[1] 

机构地区：[1]武汉大学中南医院、武汉大学肝胆疾病研究院、武汉大学移植医学中心、移植医学技术湖北省重点实验室,430071 [2]中南大学湘雅三院卫生部移植医学工程技术研究中心,长沙410013

出　　处：《中华消化外科杂志》2013年第9期676-680,共5页Chinese Journal of Digestive Surgery

基　　金：中央高校基本科研业务费专项资金（114075）;武汉市科技攻关项目（201161038344-01）

摘　　要：目的探讨自体肝移植治疗常规手术难以切除的肝脏占位性病变的临床价值。方法回顾性分析2005年5月至2011年12月武汉大学中南医院收治的36例自体肝移植患者的临床资料，分析患者术前评估情况，术中情况和术后情况。采用门诊或电话方式随访，随访时间截止2013年3月。Kaplan—Meier法绘制生存曲线。结果36例患者术前肝功能Child—Pugh分级，A级34例、B级2例。HBsAg阳性20例、阴性16例。36例患者均施行了半离体自体肝移植，手术时问为（8．34-1．5）h，无肝期为（245±12）rain，术中中位出血量为600ml，其中2例在开放肝脏血流后并发严重心律失常，其余患者手术顺利。术后肝功能恢复时间为（104-5）d。中位住院时间为28．5d，术后中位住院时问为24．0d。ALT、AST、TBil达峰值时间分别为（1．7±0．8）d、（1．34-0．6）d和（2．5±1．4）d。术后34例患者获得随访，随访率为94．4％（34／36），中位随访时间为4年。13例良性疾病患者，1例侵犯肝门部胆管及胆总管包虫病患者术后5个月复发，经RFA治疗后带病生存。20例肝癌患者术后肿瘤复发转移9例，其中1例失访，7例死亡，1例已生存5．4年。2例右肾癌癌栓蔓延至肝静脉出口平面患者，1例失访，1例已生存4．4年。1例胰腺癌肝转移术后复发患者，术后5个月肝脏转移瘤复发。36例患者自体肝移植术后1、2、3年生存率分别为75％、71％、68％，其中恶性肿瘤患者术后1、2、3年生存率分别为65％、59％、54％。结论自体肝移植患者经过完善的术前评估、严格筛选手术适应证、充分的术前准备、改进的手术技术和肝脏灌注方法，可获得较好的手术效果，术后得以长期生存。Objective To study the clinical value of autologous liver tranplantation （ALT） for the treat- ment of liver occupying lesion which can not be resected by conventional techniques. Methods The clinical data of 36 patients who received ALT at the Zhongnan Hospital of Wuhan University from May 2005 to December 2011 were retrospectively analyzed. The preoperative evaluation, intra- and postoperative conditions of the patients were analyzed. All the patients were followed up via phone call or out-patient examination till March 2013. The survival curve was drawn by Kaplan-Meier method. Results The preoperative hepatic function of 34 patients was in Child- Pugh grade A, and 2 in Child-Pugh grade B. The HBsAg was positive in 20 patients and negative in 16 patients. Thirty-six patients received ALT. The operation time was （ 8.3 ＋ 1.5 ） hours, and the anhepatic phase was （ 245 _＋ 12） minutes, the median volume of intraoperative blood loss was 600 ml. The operation was successful except 2 patients suffered from severe arrhythmia. The mean time for hepatic function recovery after the operation was （ 10 _＋ 5） days. The median time for hospital stay and postoperative hospital stay were 28.5 days and 24.0 days, respectively. The time for alanine transaminase, aspartate transaminase and total bilirubin to reach the peak level were （ 1.7 ＋ 0.8 ） days, （ 1.3 ＋ 0.6） days and （2.5 -＋ 1.4） days, respectively. Thirty-four patients were followed up with the rate of 94.4% （34/36）, and the median follow-up time was 4 years. Thirteen patients suffered from benign disease. One patient with hydatidosis invading the hilar bile duct and common bile duet had hydatidosis recurrence at postoperative month 5, and he received radiofrequency ablation. Of the 20 patients with hepatic cancer, 9 had tumor recurrence or metastasis （ 1 missed follow-up, 7 died and 1 survived for 5.4 years）. Of the 2 patients with hepatic vein invaded by right renal carcinoma, 1 nfissed follow-up and 1 survived for 4.4 years

关 键 词：肝移植 自体 疗效 生存率 

分 类 号：R657.3[医药卫生—外科学]