人工肝支持系统并同种异体肝移植治疗重症肝炎5例(英文)

Artificial liver support system combined with allotransplantation for the treatment of serious hepatitis in 5 cases

背景:由于肝移植的特殊性,目前面临的最大的问题是能否及时获得供体进行肝移植治疗,另外寻找合适的肝移植前过渡支持方法,以提高手术成功率,改善患者预后也是目前该领域的重点之一。目的:观察在人工肝支持系统支持下行同种异体肝移植治疗重症肝炎的效果。设计:回顾性病例分析。单位:安徽医科大学第三附属医院普外科器官移植中心。对象:选择2004-06/2005-05安徽医科大学第三附属医院器官移植中心在人工肝支持系统支持下行同种异体肝移植治疗重症肝炎5例,均为男性,年龄25～48岁。纳入患者均符合2000-09西安全国传染病与寄生虫学术会议关于重症肝炎的诊断和分期标准;符合常规肝移植指征;患者和家属均对治疗知情同意。治疗方案经医院伦理委员会批准。方法:全部患者在肝移植前采用非生物型人工肝行血浆置换和持续静脉血液滤过的方式行人工肝支持治疗。取来自于20～38岁男性成人的供肝,肝移植前均取得本人及其直系亲属的许可,并签署器官捐献同意书。5例肝移植受者均行经典非转流原位肝移植。主要观察指标:肝移植后随访31～38个月,每个月回院复查肝肾功能。结果:5例肝移植均获得成功,其中1例患者在肝移植后出现肾功能衰竭及肺部感染,于肝移植后2周死亡;另外4例在随访期间未出现排异反应,乙型肝炎复发等不良并发症,4例患者生活工作正常。结论:同种异体肝移植是治疗重症肝炎有效方法,人工肝支持系统可作为肝移植前过渡支持治疗的有效手段。

BACKGROUND：The maximal problem of patient with serious hepatitis and surgical doctor is whether they can get donator and rational therapy timely. Looking for the suitable preoperative therapy method to enhance the success rate of operation and improve patient＇s prognosis is the focus of this domain. OBJECTIVE： To investigate the therapeutic effect of artificial liver support system （ALSS） combining with allotransplantation of the liver on patients with serious hepatitis. DESIGN： Retrospective case analysis. SETTING： Organ Transplantation Center, the Third Affiliated Hospital of Anhui Medical University. PARTICIPANTS： Five male patients with serious hepatitis who underwent allograft liver transplantation were selected from Organ Transplantation Center, the Third Affiliated Hospital of Anhui Medical University form June 2004 to May 2005. Their age ranged from 25 to 48 years. Inclusion criteria： The diagnosis was in accordance with phase standard established at the National Infectious Disease and Parasitology Academic Meeting in September 2000; all patients had signs of routine liver transplantation; their patients fiercely requested the operation. METHODS： Plasma exchange （PE） combined with continuous veno-venous hemofiltration （CVVH） technique was used in this study. Donor who supplied lives was from 20-38-year patients. All of them and their family agreed to donate their organ and signed the donate file before operation. All of 5 patients were used classical no-by-pass orthotopic liver transplantation （OLT）. MAIN OUTCOME MEASURES： They were follow-up visited for 21-32 months for rechecking liver and kidney function, RESULTS： All of 5 patients＇ operation was succeeded. One continued coma postoperative and his serum creatinine and urea nitrogen raised up progressively and complicated by pulmonary infection 1 week after operation and died 2 weeks after operation although given medical treatment hemodialysis positively. The rest recovered well. All of them discharged one month after operation smoothly. CONCLUSION： Allotransplantation of the liver is an utilizable method to treat serious hepatitis. ALSS can be used as an effective method of supportive treatment preoperatively.