背驮式肝移植成功19例报告

Piggy-back orthotopic liver transplantation(A report of 19 cases)

目的 总结背驮式肝移植成功的经验。方法 从 1996年 6月 2 6日开始施行首例肝移植至 2 0 0 4年 6月为 19例患终末期肝病的受者施行了背驮式肝移植 2 0次。 19例受者中 ,原发性胆汁性肝硬化 1例 ,硬化性胆管炎 1例 ,肝炎后肝硬化 6例 ,原发性肝癌并肝硬化 9例 (<5cm 4例 ,晚期肝癌 2例 ) ,多发性肝囊肿并肾囊肿 2例 (其中 1例施行了肝肾联合移植 ,另 1例先施行了背驮式肝移植 ,因慢性排斥反应 ,3个月后施行肝肾联合移植 )。 16例 17次供肝流出道采用受体的肝右肝中肝左静脉成形为一个口与供体的肝上下腔静脉端端吻合 ,3例供肝流出道采用受体的肝中肝左静脉、下腔静脉前壁成形为一个口与供体的肝上下腔静脉端端吻合。在胆道重建时 ,11例 12次为胆总管端 -端间断吻合T管引流 ,8例胆总管端 -端间断吻合无T管引流。结果 手术全部获得成功 ,存活 14例 ,4年 6个月 1例 ,1～ 3年以上 7例 ,6个月以上 3例 ,3例不足两个月 ,出院的患者都恢复工作。死亡 5例中第 1例术后 4 9天死于霉菌性败血症 ,2例多发性肝囊肿并肾囊肿施行肝肾联合移植分别于术后 31天和 3个月死于移植肾无功能。 2例晚期肝癌于术后 3个月和 5个月死于肝癌复发。结论 背驮式肝移植术可以作为一个常规术式应用。

Objestive To summarize the experiences on piggy-back orthotopic liver transplantation(POTL). Methods The first piggy-back orthotopic liver transplantation was performed in our hospital on June 26,1996.Since then all together 19 consecutive cases have been successfully treated by POTL,including 6 cases cirrhosis,9 cases hepatocellular carcinoma,2cases polycystic liver disease with polycystic renal disease,1case sclerosing cholangitis and 1case biliary cirrhosis.16 cases were treated by conventional POTL for 17 times and 3 cases were done by modified POTL. 11 of their common bile ducts were builded by end to endanastomosis withT tube, 8 cases' common bile ducts were builded by end to end anastomosis without T tube.Results 14 cases are surviving well, including one being alive for 4 and half year,7 cases for 1～3 years,3 cases for 6～12 months and 3 cases for 1～2months. 5cases died.Conclusion Piggy-back orthotopic liver transplantation(POTL) can be employed for the recipients with end-stage liver disease as a conventional surgery. The benign end-stage liver diseases are the best indication for orthotopic liver transplantation.