肝移植治疗多囊肝11例疗效分析  

Liver transplantation for polycystic liver disease: 11 cases report and literature review

作　　者：唐晖[1] 丁凡[1] 姚嘉[1] 许赤[1] 张剑[1] 汪根树[1] 易述红[1] 李华[1] 杨扬[1] 陈规划[1] Tang Hui;Ding Fan;Yao Jia;Xu Chi;Zhang Jian;Wang Genshu;Yi Shuhong;Li Hua;Yang Yang;Chen Guihua(Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China)

机构地区：[1]中山大学附属第三医院肝移植中心,广州510630

出　　处：《中华医学杂志》2019年第10期767-770,共4页National Medical Journal of China

基　　金：国家自然科学基金(81570593,81770648);广东省自然科学基金(2015A030312013);广东省科技计划项目(20169013);广州市科技计划项目(201604020001);中山大学临床医学研究5010计划项目(Sun Yat-sen University Clinical Research 5010 Program,2015017,2014006).

摘　　要：目的探讨多囊肝行肝移植治疗的手术指征及安全性。方法回顾性分析中山大学附属第三医院2004年1月至2013年10月间施行的11例多囊肝患者行肝移植治疗病例资料,并对数据结果进行统计分析。结果11例患者中行改良背驮式肝移植9例,肝肾联合移植2例。中位年龄56岁,7例(63.6%)患者为Gigot Ⅱ型多囊肝,4例(36.4%)为Gigot Ⅲ型。8例(72.7%)有严重活动困难,美国东部肿瘤协作组(ECOG)评分≥3,3例(27.3%)患者肝功能为Child-Pguh C级且终末期肝病模型(MELD)评分>20。住院时间(45.4±15.3)d,在重症监护病房(ICU)停留时间(4.1±1.9)d。围手术期死亡率为18.2%,并发症发病率为63.6%。中位随访时间为111个月。2例患者死于肝肾联合移植后严重并发症。1例患者死于术后缺血性胆管炎。术后1、5和10年生存率分别为82.2%、81.8%和65.5%。结论为了提高多囊肝患者长期预后及生活质量,肝移植是治疗唯一有效和安全的方法。Objective To explore the indications and safety of orthopedic liver transplantation for polycystic liver disease (PLD). Methods Data of 11 patients with PLD who underwent orthotopic liver transplantation between 2004 and 2013 was retrospectively analyzed. Demographic, clinical and follow-up data were collected for statistical analysis. The survival rate was calculated by Kaplan-Meier method. Results Over a period of 10 years, the patients received modified piggyback orthopedic liver transplantation (n=9) or combined liver-kidney transplantation (n=2) for PLD. The recipients′ median age was 56 years. Seven patients were classified as Gigot type Ⅱ PLD, and four were classified as Gigot type Ⅲ PLD. Eight patients had severe decreased mobility (Eastern Cooperative Oncology Group, ECOG≥3). Only three cases were Child-Pguh Class C patients and the model for end-stage liver disease (MELD) score was>20. The mean hospitalization duration was (45.4±15.3) days, and the mean length of stay in intensive care unit was (4.1±1.9) days. The perioperative mortality was 18.2% and morbidity of complications was 63.6%. The median follow-up period was 111 months. Two patients died of severe complications after combined liver-kidney transplantation. One patient died of ischemia cholangitis during follow-up. The actuarial 1-, 5-and 10-year survival rate during the follow-up period was 82.2%, 81.8%, and 65.5%, respectively. Conclusions Liver transplantation is the only curative and safe procedure for PLD, and it provides a good long-term prognosis and high quality of life for PLD patients. Liver transplantation could be a primary option in treating progressive or advanced PLD.

关 键 词：多囊肝 肝移植 乙型肝炎 

分 类 号：R657.3[医药卫生—外科学]