辅助性左肝移植治疗高MELD评分肝硬化患者  

Auxiliary left liver transplantation for treatment of a patients with liver cirrhosis and high MELD score

作　　者：王少发 陈知水[1,2] 陈栋[1,2] 魏来[1,2] 蒋继贫[1,2] 罗鸿昌[3] 李开艳 陈根 汤浩 李震 夏黎明 胡道予[4] 腾文浩[5] 张万广[5] 张必翔 陈孝平[1,2,5] Wang Shaofa;Chen Zhishui;Chen Dong;Wei Lai;Jiang Jipin;Luo hongchang;Li Kaiyan;Chen Gen;Tang Hao;Li Zhen;Xia Liming;Hu Daoyu;Teng Wenhao;Zhang Wanguang;Zhang Bixiang;Chen Xiaoping(Institute of Organ Transplantation,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,Hubei,China;Ministry of Health/Education,Key Laboratory of Organ Transplantation,Wuhan 430030,Hubei,China;Department of Ultrasound,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,Hubei,China;Department of Radiology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,Hubei,China;Liver Surgery Center,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,Hubei,China)

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究所,湖北武汉430030 [2]教育部/卫生计生委器官移植重点实验室,湖北武汉430030 [3]华中科技大学同济医学院附属同济医院B超室,湖北武汉430030 [4]华中科技大学同济医学院附属同济医院放射科,湖北武汉430030 [5]华中科技大学同济医学院附属同济医院肝脏外科,湖北武汉430030

出　　处：《实用器官移植电子杂志》2020年第6期477-480,共4页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：国家卫计委卫生行业科研专项项目(201302009);国家自然科学基金面上项目(81373168);国家重点基础研究发展计划子课题(2013CB530803)。

摘　　要：目的探讨辅助性肝移植在高终末期肝病评分(model for end-stage liver disease,MELD)肝硬化患者中的应用。方法检测患者术前肝功能评级、MELD评分、体能状态。观察受者术后肝功能恢复情况和并发症的发生及处理。结果劈离的带肝中静脉的左半肝移植物重量为410 g,移植物受体体重比为0.82%。受者术后当天肝酶最高(丙氨酸转氨酶为420 U/L,天冬氨酸转氨酶为1788 U/L)。术后第5天常规行增强CT确诊移植肝肝动脉血栓形成,予以保守治疗和观察。总胆红素术后第16天升至最高(387μmol/L),术后2个月缓慢降至正常。术后3个月增强CT清楚显示移植肝肝动脉血流恢复。受者随访6个月,肝功能正常,无其他并发症发生。结论辅助性肝移植治疗高MELD评分肝硬化患者是可行的,体能状态3级的患者可以考虑辅助性肝移植。行辅助性左肝移植时需要尽量预防和积极治疗肝动脉血栓形成。Objective To explored the application of auxiliary liver transplantation in a end-stage liver cirrhosis patient with high MELD score.Methods The preoperative liver function rating,MELD score and physical status of patients were tested.The recovery of liver function and the occurrence and treatment of complications were observed.Results The weight of the split left liver graft with middle hepatic vein was 410 g and the ratio of graft to recipient weight was 0.82%.The liver enzymes of the recipient were the highest on the day after operation(ALT 420 U/L,AST 1788 U/L).On postoperative 5th day,routine contrast-enhanced CT found liver graft hepatic artery thrombosis,and conservative treatment was performed for observation.Total bilirubin level rose to a maximum of 387μmol/L on postoperative16th day,and slowly decreased to normal 2 months after the operation.Three months after the operation,enhanced CT clearly showed the recovery of hepatic artery blood flow in the transplanted liver.The patient was followed up for 6 months with normal liver function and no other complications.Conclusion Auxiliary liver transplantation is feasible for a liver cirrhotic patient with high MELD score,and it could be considered in the patient with performance status grade 3.It should be maximized to prevent and treat hepatic artery thrombosis during auxiliary left liver transplantation.

关 键 词：辅助性肝移植 肝硬化 高MELD评分 肝动脉血栓 体能状态 

分 类 号：R657.3[医药卫生—外科学]