人工肝脏支持系统在肝脏移植围手术期的应用

Application of Artificial Liver Support System in Orthotopic Liver Transplantation

目的探讨人工肝脏支持系统(Artificialliversupportsystem,ALSS)应用于人体原位肝移植围手术期的经验体会。原位肝移植加人工肝支持疗法对急慢性肝功能衰竭的疗效及人工肝支持系统在急慢性肝功能衰竭肝移植术前准备和术后起到辅助的作用。方法回顾性分析2001年7月至2004年5月本院实施的21例肝脏移植中4例患者在移植前后进行ALSS治疗的临床资料。本组4例患者,均有不同程度的肝昏迷、黄疸、腹水、肝功能损害、出血倾向。在等待供肝的过程中及移植术后分别接受2-11次非生物型人工肝支持疗法,供肝到达后行原位肝移植术。结果人工肝支持治疗后患者血清胆红素明显下降,腹水明显减少,部分患者肝性脑病有所好转。4例均顺利行肝移植:3例存活6-20个月;其中2例已存活1年以上,并已逐步恢复正常工作;1例术后10天脑死亡。结论ALSS能纠正机体术前的内环境失衡,为供肝等待和增加手术耐受创造条件,应作为肝脏移植前积极准备的重要部分,术前人工肝支持可作为暴发性肝功能衰竭等待供肝期间的桥梁,并可改善病情,减少肝移植的危险因素;ALSS为术后移植功能发挥欠佳者提供了有力支持和恢复功能的机会。原位肝移植加人工肝支持疗法是治疗急慢性肝功能衰竭的有效方法。

Objective To discuss the experience of application of artificial liver support system（ALSS） during perioperative period of orthotopic liver transplantation（OLT）. Methods The clinical data of 4 patients receiving ALSS treament of totally 21 patients who underwent liver transplantation consecutively between July 2001 and May 2004 were analyzed retrospectively. Results Decreased serum bilirubin, improved hepatic eneephalopathy and aseeites were achieved in all 4 cases after ALSS. Three in 4 have survived for 6 to 20 months after OLT, of whom 2 have had excellent quality of life for more than 12 months,but one patient died ten days after OLT. Conclusion The timely application of ALSS provides necessary and valuable support to patients during pefioperative period of OLT. Preperation of ALSS treatment should be applied actively as an important component of preparation for OLT ,and post operative ALSS treatment can give asistance to resume normal function of allograft.