肝移植术后长期存活患者生存情况单中心分析  

Survival of long-term survivors after liver transplantation:a single-center analysis

作　　者：李嘉伟 庄雅峰 王明 柯瑞盛 江艺 蔡秋程 Li Jiawei;Zhuang Yafeng;Wang Ming;Ke Ruisheng;Jiang Yi;Cai Qiucheng(Clinical Medical College,Fuzhou General Hospital of Fujian Medical University,Fuzhou 350025,China;Department of Hepatobiliary Surgery,the 900th Hospital of Joint Logistics Support Force of Chinese PLA,Fuzhou 350025,China;Department of General Surgery,Dongfang Hospital Affiliated to Xiamen University,Fuzhou 350025,China;Department of General Surgery,the First Affiliated Hospital of Xiamen University,Xiamen 361001,China)

机构地区：[1]福建医科大学福总临床医学院,福州350025 [2]解放军联勤保障部队第九〇〇医院肝胆外科,福州350025 [3]厦门大学附属东方医院普通外科,福州350025 [4]厦门大学附属第一医院普通外科,厦门361001

出　　处：《中华肝脏外科手术学电子杂志》2022年第2期182-187,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：福建省自然科学基金(2020Y0078);福建省自然科学基金青年创新项目(2020J05299);厦门市医疗卫生指导性课题项目(3502Z20209011)。

摘　　要：目的探讨肝移植术后长期存活(生存时间≥10年)患者生存情况。方法回顾性分析2005年1月至2010年12月解放军联勤保障部队第九○○医院行肝移植术后长期存活的104例患者临床资料。其中男91例,女13例;年龄15~71岁,中位年龄45岁。术前HBsAg阳性77例,阴性27例。患者均签署知情同意书,符合医学伦理学规定。观察患者肝移植术后胆道并发症、恶性肿瘤新发或复发、乙型病毒性肝炎(乙肝)新发或复发、感染、肾功能损害、代谢性并发症、心脑血管并发症、排斥反应等发生情况及死因。结果肝移植术后长期存活占同期手术患者的46.0%(104/226),其中原发性肝癌30例、胆管癌3例、肝衰竭64例、肝豆状核变性7例。随访时间120~191个月,中位随访时间142个月。随访期间胆道并发症10例,肿瘤复发5例、新发9例,乙肝复发6例、新发5例,肺部感染15例,结核感染5例,肾功能损害22例,高血压病34例,糖尿病31例,高脂血症29例,冠状动脉粥样硬化性心脏病7例,排斥反应18例。随访期间死亡6例,死于肺部感染3例,恶性肿瘤新发和(或)复发2例,慢性排斥反应1例。结论术后胆道并发症、恶性肿瘤及乙肝新发和复发、感染、肾功能损害、代谢性并发症、心脑血管并发症、排斥反应等对肝移植患者术后长期存活有重要影响,肺部感染、恶性肿瘤新发和复发是主要死因。Objective To investigate the long-term survival(survival time of≥10 years)of the recipients after liver transplantation.Methods Clinical data of 104 patients who achieved long-term survival after liver transplantation in the 900th Hospital of Joint Logistics Support Force of Chinese PLA from January 2005 to December 2010 were retrospectively analyzed.Among them,91 patients were male and 13 female,aged from 15 to 71 years,with a median age of 45 years.Prior to liver transplantation,77 cases were positive and 27 cases were negative for HBsAg.The informed consents of all patients were obtained and the local ethical committee approval was received.The incidence of biliary complications,de novo or recurrent malignant tumors,de novo or recurrent hepatitis B virus infection(hepatitis B),infection,renal function damage,metabolic complications,cardio-cerebrovascular complications,rejections and causes of death after liver transplantation were observed.Results The long-term survival rate after liver transplantation was 46.0%(104/226),including 30 cases of primary liver cancer,3 cases of cholangiocarcinoma,64 cases of liver failure and 7 cases of hepatolenticular degeneration.Postoperative follow-up time was ranged from 120 to 191 months,with a median of 142 months.During the postoperative follow-up,10 cases of biliary complications,5 recipients developed malignant tumor recurrence,9 cases of de novo tumors,6 cases of recurrent hepatitis B,5 cases of de novo hepatitis B,15 cases of pulmonary infection,5 cases of tuberculosis infection,22 cases of renal function damage,34 cases of hypertension,31 cases of diabetes mellitus,29 cases of hyperlipidemia,7 cases of coronary atherosclerotic heart disease and 18 cases of rejections.6 recipients died during follow-up,including 3 cases of pulmonary infection,2 cases of de novo and/or recurrent malignant tumors and 1 case of chronic rejection.Conclusions Postoperative biliary complications,de novo and recurrent of malignant tumors and hepatitis B,infection,renal function damage,meta

关 键 词：肝移植 预后 存活率分析 

分 类 号：R73[医药卫生—肿瘤]