小儿终末期肝病肝移植术式选择(附15例报告)

Clinical features and outcome of pediatric liver transplantation

目的探讨小儿终末期肝病的临床特点及肝移植术式选择。方法天津市第一中心医院于2000年8月至2007年11月对15例年龄≤12岁终末期肝病患儿施行18次肝移植手术。2000—2004年前的7例10次手术均为减体积肝移植,2006年后实施的8例肝移植中4例为劈离式、4例为活体部分肝移植。术后均给予抗排斥、抗感染、抗凝等治疗,密切监测移植肝血流及肝功能变化。结果术后各种并发症的发生率分别为急性排斥反应20.0%、感染73.3%、胆管并发症33.3%、肝动脉栓塞20.0%、腹腔出血13.3%。4例(26.7%)患儿因腹腔感染、出血、血栓形成再次手术,其中2例血栓形成患儿分别行二次、三次肝移植,再移植率为13.3%。死亡4例(26.7%),其余11例患儿随访1年1个月至8年4个月(至2008年12月),健康存活。结论肝移植是治疗小儿终末期肝病的有效方法,积极防治术后并发症是其成功的关键。

Objective To investigate the clinical features and efficacy of pediatric liver transplantation. Methods Analyze the clinical data of 15 children （age ≤ 12yr） who underwent 18 liver transplantations from August 2000 to November 2007. We performed 10 reduced-size liver transplantations for 7 children before 2004, four split and four living related liver transplantations for 8 children after 2006. Immunosuppressants, antibiotics and anticoagulation were administered after operation. Results The incidences of the complications following the operations were： acute rejection （20.0%）, infection（73.3%）biliary complications （33.3%）, hepatic artery thrombosis （20.0%）, and abdominal bleeding （13.3%）. Four children （26.7%） had to receive re-operations for abdominal infection or hemorrhage or thrombosis. Among them, one received second and one received third fiver transplantation because of thrombosis, and the re-transplantation rate was 13.3%. Four recipients died （26.7%）, the rest 11 children enjoyed good liver function with a follow-up range from 13 months to 8 years and 4 months. Conclusion Liver transplantation is an effective treatment for children with end-stage liver diseases. It＇ s critical to prevent and manage the complications.