24例原位肝移植经验总结

Management of 24 patients treated with orthotopic liver transplantation:Experience summary

目的总结肝移植治疗晚期肝硬化、肝癌的经验。方法采用原位肝移植治疗24例肝脏疾病,其中乙型肝炎后肝硬化(失代偿期)7例；酒精性肝硬化1例；重症乙肝3例；乙型肝炎后肝硬化合并肝癌13例。结果随访2个月至3年,平均14个月。病死4例,其中死于肺和脑霉菌感染者1例,死于腹腔感染并胆漏者1例,死于多器官功能衰竭者1例。13例肝癌患者中死于肝癌复发者2例(均为巨块、浸润型),其余患者生存良好。结论肝移植是治疗终末期肝病的有效方法,尤其对于良性疾病及部分特殊病例,如合并巨大量乳糜胸、乳糜腹者,效果尤佳。对于肝肾综合征者也有良效；注意对肝癌病例的选择,尤其是巨块、浸润型；注意并发症的早发现和早防治。

Objective To summarize the experience of treating advanced hepatocirrhosis and advanced liver carcinoma with liver transplantation.Methods 24 patients with hepatic diseases were treated with orthotopic liver transplantation.Of the 24 patients,there were 7 patients with hepatocirrhosis after B hepatitis;one patient with alcoholic hepatocirrhosis; 3 patients with severe type of B hepatitis;13 patients with hepatocirrhosis after B hepatitis combined carcinoma.Results The follow-up time was from 2 monthes to 3 years, averaged 14 monthes. In these patients,4 has died,among them one patient was died from mycotic pneumonia and fungal meningitis,one patient from abdominal infection and biliary leakage, one patient from multiple organ system failure,2 patients with hepatocirrhosis after B hepatitis combined carcinoma from recuring of the carcinoma （all the patients＇s pathological type were massive and infiltrative type hepatic cell carcinoma.Conclusions Liver transplantation is a useful method for treating the end stage hepatic disease,especially the benign disease and partment of special disease,such as combined enormous chylothorax and chyloperitoneum.For hepatic-renal syndrome,liver transplantation has an excellent effect too.But for the hepatic carcinoma,indications of which must be chosen carefully, especially the massive and infiltrative type;complications after liver transplantation must be needed to find and provided preventation and cure early.