手术治疗成人严重多囊肝疗效分析  

Efficacy of operative management for the treatment of severe adult polycystic liver disease

作　　者：邹游 傅志仁 施晓敏 ZU You;FU Zhiren;SHI Xiao-min(Department of Liner Surgery.Shanghai Changzheng Hospital,Shanghai 00003,China)

机构地区：[1]上海长征医院肝脏外科,上海200003

出　　处：《肝胆外科杂志》2024年第3期168-171,共4页Journal of Hepatobiliary Surgery

摘　　要：目的评价手术(包括部分肝切除加囊肿广泛开窗术以及肝移植术)治疗成人严重多囊肝病(SAPLD)的疗效。方法对2003~2023年12例在我院行部分肝切除加囊肿广泛开窗术SAPLD患者的术前临床症状、术后并发症及预后进行分析,并对同期3例SAPLD患者行原位肝移植的临床资料进行回顾性分析。结果果部分肝切除加囊肿广泛开窗术组平均随访105个月。4例患者于术后102、45、39、30个月症状复发,1例于术后66个月死于肝囊腺瘤,1例术后肝功能不全患者行原位肝移植。术后6例患者出现并发症,其中出血1例,胆漏1例,严重腹水2例,胸腔积液2例。总并发症发病率为50%。肝移植组3例SAPLD患者接受了肝移植手术。患者的中位年龄为55岁。3例均为Gigot Ⅲ型SAPLD。所有病例均为Child-Pugh C级患者,终末期肝病模型(MELD)评分均>20分。中位无肝期和手术失血量分别为40min(35~55min)和1200ml(600~10000ml)。中位住院时间为21天(0~31天),中位重症监护病房停留时间为3天(0~7天)。1例在移植过程中死于大出血。中位随访时间63个月(0~178个月),目前1例存活15年以上,1例存活5年以上,随访结束时未发现移植肝急性排斥反应,生活质量良好。结论部分肝切除加囊肿广泛开窗术治疗SAPLD是一种安全可行的方法,而肝移植是治疗SAPLD唯一有效和彻底的方法,肝移植为SAPLD患者提供了良好的长期预后和高质量的生活。Objective To evaluate therapeutical effect of combined heptic resection and fenestration and liver transplantation for severe adult polycystic liver disease(SAPLD).Methods Preoperative clinical symptoms,postoperative complications and prognosises from 12 patients with SAPLD treated with combined hepatic resection and fenestration between 2003 and 2023 were recorded.And in same period data of 5 patients with SAPLD who underwent orthotopic liver transplantation was retrospectively analyzed.Demographic,clinical and follow-up data were collected for analysis.Results In combined heptic resection and fenestration group.The mean follow-up time was 105 months.There were four patients with recurrence of symptoms at 102,45,39 and 30 months after operation.One patient died of liver failure due to cystadenoma of liver at 66 months after first operation.And one patient with postoperative hepatic in adequacy recieved an orthotopic liver transplantation.The total number of patients with postoperative complications was 6 cases,including one patient with bleeding,one patients with bile leakage,two patients with severe ascites and two patients with pleural effusion.and the overall incidence was 50%.In liver transplantation group,over a period of 15 years,three patients received orthopedic liver transplantation for SAPLD.The recipients'median age was 55 years.All patients were classified as Gigot type Ⅲ SAPLD,and all cases were Child-Pugh Class C patients and the model for end-stage liver disease(MELD)score was>20.The median anhepatic phase and operative blood loss were 40minutes(range,35-55 minutes)and 1200ml(range,600-12000 ml),respectively.The median hospitalization duration was 21 days(range,0-31 days),and the median length of stay in intensive care unit was 3days(range,0-7 days).One patients died of severe bleeding during transplantation.The median follow-up time was 63 months(range,0-178 months).One patient survived for more than 15 years,one patients survived for more than 5 years.No acute rejection of grafts was observed

关 键 词：成人严重多囊肝病 肝切除 开窗术 肝移植 预后 

分 类 号：R659[医药卫生—外科学]