重型肝炎肝移植的围手术期处理

Perioperative management of orthotopic liver transplantation in patients with severe hepatitis

目的总结重型肝炎病人肝移植围手术期若干问题的处理经验。方法对中山大学附属第三医院肝移植中心2004年6月至2006年6月完成的218例重型肝炎肝移植病例资料进行回顾性分析。结果218例重型肝炎肝移植围手术期成活率92．7％（202／218），其中急性重型肝炎肝移植为90．4％（57／63），慢性重型肝炎肝移植为93．5％（145／155）。术后常见的并发症分别为感染（74．7％）、肝移植相关性脑病（65．6％）和肾功能不全（14.7％）。结论重型肝炎肝移植的围手术期死亡率高，重视围手术期的处理是提高重型肝炎肝移植成功率的关键。

Objective To evaluate and summarize the experience in perioperative management of orthotopic liver transplantation （OLT） in patients with severe hepatitis. Methods The clinical data of 218 patients with severe hepatitis undergoing OLT in our hospital from June 2004 to June 2006 were retrospectively analyzed. Results The survival rate in perioperative period was 92.7% （202/218）, in which the acute severe hepatitis was 90.4% （57/63）, chronic severe hepatitis was 93.5% （145/155）. The common complications included infection （74.7 %）, liver transplantation related encephalopathy （65.6%） and acute renal failure （14.7 %）. Conclusion Perioperative mortality is high in patients with severe hepatitis receiving liver transplantation. Effective perioperative management is important to improve survival rate of the patients with severe hepatitis after OLT.