原位肝移植治疗急性肝功能衰竭21例临床分析

Liver transplantation for acute hepatic failure:a report of 21 cases

目的探讨原位肝移植治疗急性肝功能衰竭的临床疗效。方法回顾性分析天津市第一中心医院21例因急性肝功能衰竭行原位肝脏移植术病人的临床资料，总结急性肝衰竭实施肝移植的经验。结果21例病人随访时间为3～60个月，中位随访时间为25个月。生存时间为1—1530d，中位生存时间为517d。病人的围手术期存活率为66．7％，1年存活率为66．7％，2年存活率为66．7％。死亡原因包括多脏器功能衰竭、颅内出血、上消化道出血、急性成人呼吸窘迫综合征、移植物原发性无功能。14例的远期性生存病人中，13例移植前合并乙型肝炎（乙肝），其中有1例（1／13）在术后1年出现乙肝复发。结论肝移植术是治疗急性肝功能衰竭最有效的方法，严格把握适应证、合理选择手术时机是提高疗效的关键。

Objective To investigate the effect of orthotropic liver transplantation（OLT） in treatment for acute hepatic failure （AHF） patients. Methods A retrospective review was undertaken on the clinical data of 21case undergoing liver transplantation for AHF. Results In 21case, the follow-up time was 3 to 60 months with the median follow-up time as 25 months. The survival time was 1 to 1 530 days with the median as 517dyas. The one month survival rate was 66. 7% ,and the 1 year and 2year survival rate were 66. 7% the same. The causes of death cases were included：infection, multiple organ failure, acute respirator distress syndrome, intracalvarium hemorrhage, upper digestive tract hemorrhage and primary non-function. One of the 13 HBV relative was HBV recurrence in one year after OLT. Conclusion Liver transplantation was effective in the treatment of AHF. The key points to elevate the effect were strict indication and good operation opportunity.