再次肝移植的原因与手术时机的选择

Liver retransplantation, clinical analysis of 6 cases

目的探讨再次肝移植的原因与手术时机的选择。方法本移植中心1999年7月至2004年12月共实施的164例肝移植中,再次肝移植6例,其中因缺血再灌注损伤致肝内胆管多发狭窄3例,肝动脉狭窄和血栓1例,乙肝复发1例,肝静脉流出道梗阻1例。再移植率为3．65％,再次肝移植均采用改良背驮式肝移植技术。结果6例再次肝移植术后临床症状改善4例,无明显改善 2例。术后腹腔出血2例,胆漏1例,腹腔细菌感染1例,霉菌感染2例,术后4月内死于细菌和霉菌感染2例,保守治疗治愈4例。结论供肝缺血再灌注损伤致肝内胆管狭窄或消失是国内再次肝移植的主要原因．对于各种治疗均无法改善移植肝肝功能,肝功能进行性恶化,应该尽早行再次肝移植。

Objective To explore causes leading to and the timing of liver retransplantation. Methods Among 164 cases of liver transplantation from Jul. 1999 to Dec. 2004, 6 cases underwent retransplantation with an incidence of 3.65%. Causes included multiple intrahepatic bile duct stricture by ischemic reperfusion injury in 3 cases, hepatic artery stricture and thrombosis, hepatitis B recurrence, outflow obstruction of hepatic veins in one each. Results Clinical symptom improved in 4 cases, and failed to improve in 2 cases. Two cases suffered from intraahdominal bleeding, one hiliary leak, one bacterial infection, two mold infection. Two patients died from bacterial and mold infection in four months. Conclusion lschemie reperfusion injury is main cause retransplantation should he performed when the function therapy fails. resulting in intrahepatie bile duct stricture, liver of graft deteriorates significantly and conservative