18例自体肝移植围手术期技术与处理

Techniques and management of liver autotransplantation in perioperative stage in 18 cases

目的探讨自体肝移植(liver autotransplantation,LA)围手术期相关技术,规范LA的诊治流程。方法回顾性分析我院2005—2007年间18例接受LA手术患者的病例资料,初步总结LA手术适应证及围手术期并发症发生与处理的经验。结果18例LA术中、术后共计各类并发症13例次,其中术中心律失常和术后出血、胸水、胆漏、败血症、小肝综合征等是围手术期常见并发症。结论LA较常规肝切除并发症多,如能及时诊断处理并不影响围手术期疗效。该技术为常规难以切除或切除困难的肝占位性病变开辟了新的技术径路,远期疗效尚在随访中。

Objective To explore the relevant techniques of liver autotransplantation （LA） in perioperative stage and standardize the precedures of diagnosis and treatment of LA. Methods A retrospective study was made on the case data of 18 patients who received LA in our hospital between 2005--2007. Operational indications and experience in the occurrence and the management of perioperative complications of LA were summarized. Results In 18 cases,13 complications occurred during and after operation, mainly including cardiac arrhythmias during the operation, postoperative bleeding, pleural fluid, bile leak, septicemia and small-for-size syndrome. Conclusions LA has more complications than routine hepatectomy, but the outcomes will be satisfying if these complications are handled in time. LA creats a new way to cure those whose hepatic space-occupying lesions are impossible or difficult to be resected. The long-term outcomes are still in the follow-up.